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      Bench-to-bedside review: Rapid molecular diagnostics for bloodstream infection - a new frontier?

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          Abstract

          Among critically ill patients, the diagnosis of bloodstream infection poses a major challenge. Current standard bacterial identification based on blood culture platforms is intrinsically time-consuming and slow. The continuous evolvement of molecular techniques has the potential of providing a faster, more sensitive and direct identification of causative pathogens without prior need for cultivation. This may ultimately impact clinical decision-making and antimicrobial treatment. This review summarises the currently available technologies, their strengths and limitations and the obstacles that have to be overcome in order to develop a satisfactory bedside point-of-care diagnostic tool for detection of bloodstream infection.

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          Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock.

          Anand Kumar, Paul Ellis, Yaseen Arabi … (2009)
          Our goal was to determine the impact of the initiation of inappropriate antimicrobial therapy on survival to hospital discharge of patients with septic shock. The appropriateness of initial antimicrobial therapy, the clinical infection site, and relevant pathogens were retrospectively determined for 5,715 patients with septic shock in three countries. Therapy with appropriate antimicrobial agents was initiated in 80.1% of cases. Overall, the survival rate was 43.7%. There were marked differences in the distribution of comorbidities, clinical infections, and pathogens in patients who received appropriate and inappropriate initial antimicrobial therapy (p < 0.0001 for each). The survival rates after appropriate and inappropriate initial therapy were 52.0% and 10.3%, respectively (odds ratio [OR], 9.45; 95% CI, 7.74 to 11.54; p < 0.0001). Similar differences in survival were seen in all major epidemiologic, clinical, and organism subgroups. The decrease in survival with inappropriate initial therapy ranged from 2.3-fold for pneumococcal infection to 17.6-fold with primary bacteremia. After adjustment for acute physiology and chronic health evaluation II score, comorbidities, hospital site, and other potential risk factors, the inappropriateness of initial antimicrobial therapy remained most highly associated with risk of death (OR, 8.99; 95% CI, 6.60 to 12.23). Inappropriate initial antimicrobial therapy for septic shock occurs in about 20% of patients and is associated with a fivefold reduction in survival. Efforts to increase the frequency of the appropriateness of initial antimicrobial therapy must be central to efforts to reduce the mortality of patients with septic shock.
          Article 0 comments Cited 347 times – based on 0 reviews     Review now
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            Bacterial adhesins in host-microbe interactions.

            Kimberly Kline, Stefan Fälker, Sofia Dahlberg … (2009)
            Most commensal and pathogenic bacteria interacting with eukaryotic hosts express adhesive molecules on their surfaces that promote interaction with host cell receptors or with soluble macromolecules. Even though bacterial attachment to epithelial cells may be beneficial for bacterial colonization, adhesion may come at a cost because bacterial attachment to immune cells can facilitate phagocytosis and clearing. Many pathogenic bacteria have solved this dilemma by producing an antiphagocytic surface layer usually consisting of polysaccharide and by expressing their adhesins on polymeric structures that extend out from the cell surface. In this review, we will focus on the interaction between bacterial adhesins and the host, with an emphasis on pilus-like structures.
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              Epidemiology of sepsis in Germany: results from a national prospective multicenter study.

              Christoph Engel, Frank Brunkhorst, Hans-Georg Bone … (2007)
              To determine the prevalence and mortality of ICU patients with severe sepsis in Germany, with consideration of hospital size. Prospective, observational, cross-sectional 1-day point-prevalence study. 454 ICUs from a representative nationwide sample of 310 hospitals stratified by size. Data were collected via 1-day on-site audits by trained external study physicians. Visits were randomly distributed over 1 year (2003). Inflammatory response of all ICU patients was assessed using the ACCP/SCCM consensus conference criteria. Patients with severe sepsis were followed up after 3 months for hospital mortality and length of ICU stay. Main outcome measures were prevalence and mortality. A total of 3,877 patients were screened. Prevalence was 12.4% (95% CI, 10.9-13.8%) for sepsis and 11.0% (95% CI, 9.7-12.2%) for severe sepsis including septic shock. The ICU and hospital mortality of patients with severe sepsis was 48.4 and 55.2%, respectively, without significant differences between hospital size. Prevalence and mean length of ICU stay of patients with severe sepsis were significantly higher in larger hospitals and universities (
              Article 0 comments Cited 189 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Arash Afshari
                Jacques Schrenzel
                Margareta Ieven
                Stephan Harbarth
                Journal
                Journal ID (nlm-ta): Crit Care
                Journal ID (iso-abbrev): Crit Care
                Title: Critical Care
                Publisher: BioMed Central
                ISSN (Print): 1364-8535
                ISSN (Electronic): 1466-609X
                Publication date (Print): 2012
                Publication date (Electronic): 29 May 2012
                Publication date PMC-release: 29 May 2013
                Volume: 16
                Issue: 3
                Page: 222
                Affiliations
                [1 ]Infection Control Program, Geneva University Hospitals and Medical School, 4, rue Gabrielle-Perret-Gentil, CH-1211 Geneva 14, Switzerland
                [2 ]Department of Anaesthesia, Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Blegdamsvej 9, 2100, Denmark
                [3 ]Clinical Microbiology Laboratory, Geneva University Hospitals and Medical School, Geneva, Switzerland
                [4 ]University of Antwerp, Vaccine and Infectious Diseases Institute, Laboratory of Medical Microbiology, University Hospital Antwerp, Wilrijkstraat 10 2650, Antwerp, Belgium
                Article
                Publisher ID: cc11202
                DOI: 10.1186/cc11202
                PMC ID: 3580598
                PubMed ID: 22647543
                SO-VID: 94248414-0417-4e68-a91a-f40b2bd53c36
                Copyright © Copyright ©2012 BioMed Central Ltd
                History
                Categories
                Subject: Review

                ScienceOpen disciplines: Emergency medicine & Trauma
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                ScienceOpen disciplines: Emergency medicine & Trauma

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