2014, Number 1
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Rev Esp Med Quir 2014; 19 (1)
Molecular diagnosis of polymicrobial sepsis in patients in intensive care unit
Thompson BMR, Rosas SG, Lara LM, Merino GJL, Moreno SHN, Morán ME, Rodríguez GJ, Calderón RG, Rangel GSI, Salazar SJ, Núñez CR, González BJA
Language: Spanish
References: 51
Page: 52-61
PDF size: 519.12 Kb.
ABSTRACT
Sepsis continue to cause high morbidity and mortality in intensive
care unit patients, this have promoted an early and empirical use of
wide spectrum antibiotics which has selected multi-resistant strains,
unbalanced normal microflora from patient and increased illness
complications which could lead to death. Development of molecular
techniques and their gradual incursion to hospitals bring a fast, sensitive
and specific alternative diagnostic test to identify the causal agent of
sepsis, determine sensitivity or resistance of antimicrobial drugs and effectively
discriminate contaminating flora. This paper presents the results
of samples sent by the Department of Epidemiology at the Genomic Medicine Laboratory to integrate a likely picture of sepsis diagnostic
in a period between May, 2012 to September 2013, where a total of
25 samples were received (18 adults and 7 infants) and results were
obtained within 72 hours. 80% of samples were polymicrobial infections
and
Stenotrophomonas maltophilia was the main agent identified, even
for four of the cases it was detected as a single organism in the sample.
REFERENCES
Sprung CL, Sakr Y, Vincent JL, et al. An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence in Acutely ill Patients (SOAP) study. Intensive Care Med 2006;32:421–427.
Dark PM, Dean P, Warhurst G. Bench-to-bedside review: The promise of rapid infection diagnosis during sepsis using polymerase chain reaction-based pathogen detection. Crit Care 2009;13:217.
Briceño I. Sepsis: Etiología, manifestaciones clínicas y diagnóstico. Medicrit 2005;2:203–213.
An G, Namas RA, Vodovotz Y. Sepsis: From pattern to mechanism and back. Crit Rev Biomed Eng 2012;40:341–351.
Mai V, Murgas-Torrazza R, Ukhanova M, et al. Distortions in development of intestinal microbiota associated with late onset sepsis in preterm infants. PLoS One 2013;8:e52876.
Carrillo-Esper R, Carrillo-Córdova JR, Carrillo-Córdova LD. Estudio epidemiológico de la sepsis en unidades de terapia intensiva mexicanas. Cir Ciruj 2009;77:301-308.
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546-1554.
Mancini N, Carletti S, Ghidoli N, et al. The era of molecular and other non-culture-based methods in diagnosis of sepsis. Clin Microbiol Rev 2010;23:235–251.
Danai PA, Moss M, Mannino DM, Martin GS. The epidemiology of sepsis in patients with malignancy. Chest 2006;129:1432–1440.
Czura CJ. Merinoff Symposium 2010: Sepsis An international call to action. Mol Med 2010;16:157-158.
Goldstein B, Giroir B, Randolph A, the Members of the International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2-8.
Leal YA, Álvarez-Nemegyei J, Velázquez JR, et al. Risk factors and prognosis for neonatal sepsis in southeastern Mexico: analysis of a four-year historic cohort follow-up. BMC Pregnancy Childbirth 2012;12:48.
Rodríguez-Weber MA, López-Candiani C, Arredondo-García JL, y cols. Morbilidad y mortalidad por sepsis neonatal en un hospital de tercer nivel de atención. Salud Publica Mex 2003;45:90-95.
Vergnano S, Sharland M, Kazembe P, et al. Neonatal sepsis: an international perspective. Arch Dis Child Fetal Neonatal Ed 2005;90:F220–F224.
Cheng B, Xie G, Yao SL, et al. Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China. Crit Care Med 2007;35:2538-2546.
Buhimschi CS, Bhandari V, Hamar BD, et al. Proteomic profiling of the amniotic fluid to detect inflammation, infection, and neonatal sepsis. PLoS Med 2007;4:e18.
Khashu M, Osiovich H, Henry D, et al. Persistent bacteremia and severe thrombocytopenia caused by coagulasenegative Staphylococcus in a neonatal intensive care unit. Pediatrics 2006;117:340-348.
Bezirtzoglou E, Stavropoulou E. Immunology and probiotic impact of the newborn and young children intestinal microflora. Anaerobe 2011;17:369-374.
Carrillo Esper R, Peña-Perez C, Mucino-Bermejo J, y cols. Sepsis grave, choque séptico y disfunción orgánica múltiple secundaria a infección por Kluyvera ascorbata. Gac Méd Méx 2011;147:355-360.
Lucignano B, Ranno S, Liesenfeld O, et al. Multiplex PCR allows rapid and accurate diagnosis of bloodstream infections in newborns and children with suspected sepsis. J Clin Microbiol 2011;49:2252–2258.
Connell TG, Rele M, Cowley D, et al. How reliable is a negative blood culture result? Volume of blood submitted for culture in routine practice in a children’s hospital. Pediatrics 2007;119:891-896.
Dark PM, Dean P, Warhurst G. Bench-to-bedside review: The promise of rapid infection diagnosis during sepsis using polymerase chain reaction based pathogen detection. Crit Care 2009;13:217.
Vincent JL. Clinical sepsis and septic shock—definition, diagnosis and management principles. Langenbecks Arch Surg 2008;393:817–824.
Anthony RM, Brown TJ, French GL. Rapid diagnosis of bacteremia by universal amplification of 23S ribosomal DNA followed by hybridization to an oligonucleotide array. J Clin Microbiol 2000;38:781–788.
Rantakokko-Jalava K, Nikkari S, Jalava J, et al. Direct amplification of rRNA genes in diagnosis of bacterial infections. J Clin Microbiol 2000;38:32–39.
Jordan JA, Butchko AR, Durso MB. Use of pyrosequencing of 16S rRNA fragments to differentiate between bacteria responsible for neonatal sepsis. J Mol Diagn 2005;7:105–110.
Laakso S, Kirveskari J, Tissari P, Mäki M. Evaluation of highthroughput PCR and microarray-based assay in conjunction with automated DNA extraction instruments for diagnosis of sepsis. PLoS One 2011;6:e26655.
Tissari P, Zumla A, Tarkka E, et al. Accurate and rapid identification of bacterial species from positive blood cultures with a DNA-based microarray platform: an observational study. Lancet 2010;375:224–230.
Loonen AJM, Jansz AR, Stalpers J, et al. An evaluation of three processing methods and the effect of reduced culture times for faster direct identification of pathogens from BacT/ALERT blood cultures by MALDI-TOF MS. Eur J Clin Microbiol Infect Dis 2012;31:1575–1583.
Emmadi R, Boonyaratanakornkit JB, Selvarangan R, et al. Molecular methods and platforms for infectious diseases testing: A review of FDA-approved and cleared assays. J Mol Diagn 2011;13:583–604.
Loeffler J, Schmidt K, Hebart H, et al. Automated extraction of genomic DNA from medically important yeast species and filamentous fungi by using the MagNA pure LC system. J Clin Microbiol 2002;40:2240–2243.
Frye JG, Jesse T, Long F, et al. DNA microarray detection of antimicrobial resistance genes in diverse bacteria. Int J Antimicrob Agents 27;2006:138–151.
Goldenberg RL, Andrews WW, Goepfert AR, et al. The Alabama preterm birth study: Umbilical cord blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborns. Am J Obstet Gynecol 2008;198:43.e1–43.e5.
Lyon E, Wittwer CT. LightCycler technology in molecular diagnostics. J Mol Diagn 2009;11:93–101.
Murdoch DR, Anderson TP, Beynon KA, et al. Evaluation of a PCR assay for detection of Streptococcus pneumoniae in respiratory and nonrespiratory samples from adults with community-acquired pneumonia. J Clin Microbiol 2003;41:63–66.
Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589-1596.
Lehmann LE, Herpichboehm B, Kost GJ, et al. Cost and mortality prediction using polymerase chain reaction pathogen detection in sepsis: evidence from three observational trials. Crit Care 2010;14:R186.
Loens K, van Loon AM, Coenjaerts F, et al. Performance of Different Mono- and Multiplex Nucleic Acid Amplification Tests on a Multipathogen External Quality Assessment Panel. J Clin Microbiol 2012;50:977–987.
Bhat N, O’Brien KL, Karron RA, et al. Use and evaluation of molecular diagnostics for pneumonia etiology studies. Clin Infect Dis 2012;54(Suppl 2):S153-S158.
Espy MJ, Uhl JR, Sloan LM, et al. Real-time PCR in clinical microbiology: applications for routine laboratory testing. Clin Microbiol Rev 2006;19:165-256.
Peters RP, van Agtmael MA, Gierveld S, et al. Quantitative detection of Staphylococcus aureus and Enterococcus faecalis DNA in blood to diagnose bacteremia in patients in the intensive care unit. J Clin Microbiol 2007;45:3641-3646.
Carver-Brown RK, Reis AH Jr, Rice LM, et al. Design and construction of a single-tube, LATE-PCR, multiplex endpoint assay with lights-on/lights-off probes for the detection of pathogens associated with sepsis. J Pathog 2012;2012:424808.
Rice JE, Reis AH Jr, Rice LM, et al. Fluorescent signatures for variable DNA sequences. Nucleic Acids Res 2012;40:e164.
Chang SS, Hsieh WH, Liu TS, et al. Multiplex PCR system for rapid detection of pathogens in patients with presumed sepsis – a systemic review and meta-analysis. PLoS One 2013;8:e62323.
Ibrahim EH, Sherman G, Ward S, et al. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000;118:146-155.
Denton M, Kerr KG. Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia. Clin Microbiol Rev 1998;11:57-80.
Jumaa PA, Sonnevend A, Pàl T, et al. The molecular epidemiology of Stenotrophomonas maltophilia bacteraemia in a tertiary referral hospital in the United Arab Emirates 2000-2004. Ann Clin Microbiol Antimicrob 2006;5:32.
Nseir S, Di Pompeo C, Brisson H, et al. Intensive care unitacquired Stenotrophomonas maltophilia: incidence, risk factors, and outcome. Crit Care 2006;10:R143.
Looney WJ, Narita M, Mühlemann K. Stenotrophomonas maltophilia: an emerging opportunist human pathogen. Lancet Infect Dis 2009;9:312-323.
Chang JS, Flynn HW Jr, Miller D, Smiddy WE. Stenotrophomonas maltophilia endophthalmitis following cataract surgery: clinical and microbiological results. Clin Ophthalmol 2013;7:771-777.
Chiu LQ, Wang W. A case of unusual Gram-negative bacilli septic arthritis in an immunocompetent patient. Singapore Med J 2013;54:e164-168.
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