Detection of microbial DNAemia: does it matter for sepsis management?

Excerpt

Sepsis is a major cause of morbidity and premature death. In the USA, severe sepsis has been shown to cause over 200,000 deaths per year [1]. Early administration of active antimicrobial therapy is a predictor of favorable outcome in severe sepsis arising from bacteremia and pneumonia [2, 3]. However, targeting the etiological agents of sepsis is a clinical challenge as the range of pathogens and their resistance to antibiotics vary over time and place [4]. While broad spectrum empirical antimicrobial therapy allows to initially treat a majority of likely pathogens, every effort should be made to rapidly identify the causative pathogens and narrow the spectrum of therapy to minimize the development of antibiotic resistance. Currently, microbiological testing in sepsis still relies on blood cultures, microscopic examination and culture of specimens from the suspected focus of infection [5]. By nature, microbiological culture is a slow process. Typically, culture-based procedures detect bacterial pathogens within 12–48 h, but fastidious pathogens such as yeasts can take longer. By conventional methods, microbial identification and drug susceptibility profiles require a further testing time of 6–24 h after isolation. Faster identification of microbial pathogens is achievable by using mass-spectrometry [6]. False-negative results do occur with blood cultures because of low microbial inoculum or growth inhibition by residual antibiotics in the sample. Therefore, faster and more sensitive diagnostic tests are needed to better target antibiotic therapy of bacterial and fungal infections and improve the management of patients with sepsis. …