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Prospective evaluation of SeptiFast Multiplex PCR in children with systemic inflammatory response syndrome under
Franziska Gies1, Eva Tschiedel1, Ursula Felderhoff-Müser1
1Department of Pediatrics I, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
Background:
Antimicrobially pre-treated children with systemic inflammation often pose a diagnostic challenge to the physician. We aimed to evaluate the additional use of SeptiFast multiplex polymerase chain reaction (PCR) to identify causative pathogens in children with suspected systemic bacterial or fungal infection.
Methods:
Prospective observational study in 39 children with systemic inflammatory response syndrome (SIRS) under empiric antibiotic treatment. Primary outcome was the rate of positive blood cultures (BC), compared to the rate of positive SeptiFast (SF) results.
Results:
In total, 14 SF-samples yielded positive results, compared to 4 positive BC (p < 0.05). All blood cultures and 13 of 14 positive SF-tests were considered infection. Median time for positive BC was 2 days, and time to definite result was 6 days, compared to 12 h for SF. Antimicrobial therapy was adapted in 7 of the 14 patients with positive SeptiFast, and in 3 of the 4 patients with positive BC. Best predictive power for positive SF shown by receiver-operating characteristic was demonstrated for procalcitonin PCT (Area under the curve AUC: 0.79), compared to C-reactive protein CRP (AUC: 0.51) and leukocyte count (AUC: 0.46). A procalcitonin threshold of 0.89 ng/ml yielded a sensitivity of 0.82 and a specifity of 0.7. Children with a positive SeptiFast result on day 0 had a significantly higher risk to require treatment on the Pediatric Intensive Care Unit or to be deceased on day 30 (Odds-Ratio 8.62 (CI 1.44-51.72).
Conclusions:
The additional testing with SeptiFast in antimicrobially pre-treated children with systemic inflammation enhances the rate of pathogen detection. The influence of multiplex PCR on clinically relevant outcome parameters has to be further evaluated. (
Trial Registration:
DRKS00004694).
Insights
SeptiFast multiplex PCR significantly enhances pathogen detection in children with systemic inflammation, outperforming blood cultures. This rapid molecular test aids in timely antimicrobial therapy adjustments for better patient outcomes.
Area of Science:
- Medical Microbiology
- Molecular Diagnostics
- Pediatric Infectious Diseases
Background:
- Systemic inflammation in children poses diagnostic challenges, especially when pre-treated with antimicrobials.
- Accurate pathogen identification is crucial for effective treatment in pediatric sepsis.
Purpose of the Study:
- To evaluate the utility of SeptiFast multiplex PCR in identifying pathogens in children with suspected bacterial or fungal infections.
- To compare the diagnostic yield and speed of SeptiFast against conventional blood cultures.
Main Methods:
- Prospective observational study involving 39 children with systemic inflammatory response syndrome (SIRS) under antibiotic treatment.
- Comparison of positive results from SeptiFast (SF) and blood cultures (BC).
- Analysis of time to result, impact on antimicrobial therapy, and predictive value of biomarkers.
Main Results:
- SeptiFast detected pathogens more frequently (14/39) than blood cultures (4/39) (p < 0.05).
- SeptiFast provided results in 12 hours, significantly faster than blood cultures (6 days).
- Procalcitonin (PCT) showed the best predictive power for positive SeptiFast results (AUC: 0.79).
Conclusions:
- SeptiFast multiplex PCR improves pathogen detection rates in antimicrobially treated children with systemic inflammation.
- Early pathogen identification via SeptiFast may influence treatment decisions and patient outcomes.
- Further research is needed to assess the impact of multiplex PCR on clinical outcomes.
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