The Value of Combining Blood Culture and SeptiFast Data for Predicting Complicated Bloodstream Infections Caused by Gram-Positive Bacteria or Candida Species

Abstract

Management of complicated bloodstream infections requires more aggressive treatment than uncomplicated bloodstream infections.We assessed the value of follow-up blood culture in bloodstream infections caused by Staphylococcus aureus, Enterococcus spp., Streptococcus spp., and Candida spp. and studied the value of persistence of DNA in blood (using SeptiFast) for predicting complicated bloodstream infections. Patients with bloodstream infections caused by these microorganisms were enrolled prospectively. After the first positive blood culture, samples were obtained every third day to perform blood culture and SeptiFast analyses simultaneously. Patients were followed to detect complicated bloodstream infection. The study sample comprised 119 patients. One-third of the patients developed complicated bloodstream infections. The values of persistently positive tests to predict complicated bloodstream infections were as follows: SeptiFast positive samples (sensitivity, 56%; specificity, 79.5%; positive predictive value, 54%; negative predictive value, 80.5%; accuracy, 72.3%) and positive blood cultures (sensitivity, 30.5%; specificity, 92.8%; positive predictive value, 64%; negative predictive value, 75.5%; accuracy, 73.9%). Multivariate analysis showed that patients with a positive SeptiFast result between days 3 and 7 had an almost 8-fold-higher risk of developing a complicated bloodstream infection. In S. aureus, the combination of both techniques to exclude endovascular complications was significantly better than the use of blood culture alone. We obtained a score with variables selected by the multivariate model.

No effects without causes: the Iron Dysregulation and Dormant Microbes hypothesis for chronic, inflammatory diseases

“…To investigate whether dormant bacteria are present, we thus need culture‐independent methods, of which ultramicroscopic (e.g. Domingue et al ., ; Domingue, , ; Domingue & Woody, ; Ewald, ; Green, Heidger Jr & Domingue, , b ; Mattman, ; Potgieter et al ., ) and molecular sequence‐based methods (Amar et al ., ; Cherkaoui et al ., ; Fernández‐Cruz et al ., ; Gaibani et al ., ; Grif et al ., , b ; C.L. Liu et al ., ; Moriyama et al ., ; NIH HMP Working Group et al ., ; Nikkari et al ., ; Sakka et al ., ; Sato et al ., ; Valencia‐Shelton & Loeffelholz, ; Woyke, Doud & Schulz, ) are by far the most common.…”

Randomized controlled clinical trial evaluating multiplex polymerase chain reaction for pathogen identification and therapy adaptation in critical care patients with pulmonary or abdominal sepsis

“…18 The sensitivity and specificity of the LightCycler Õ SeptiFast PCR test in this current study were similar to those reported in recent studies conducted in Germany and Spain. 19,20 The Spanish group evaluated patients with complicated bloodstream infections and reported a sensitivity of 56.0% and a specificity of 79.5%. 20 It should be noted that in all these studies including the current study, 14,[18][19][20] BC results were used as the reference gold standard, even though the sensitivity of this standard diagnostic methods is also limited.…”

Clinical evaluation of commercial nucleic acid amplification tests in patients with suspected sepsis

“…For that reason, different reference standards have been used in studies assessing sepsis tests. Some have used blood culture results alone as gold standard [20,28], whereas others have considered all pathogenic findings detected by any method [16,29]. We assessed the performances of blood culture and the two NAATs by classifying all findings judged as clinically relevant as "true positives".…”