Multiplex PCR-based assay (SeptiFast) for rapid detection of pathogens in febrile neutropenia: results in 273 consecutive patients

Ref ID: 18545

Author:

R. Greco (1), D. Clerici (1), N. Mancini (1), M. Clementi (2),
F. Lorentino (1), L. Crucitti (1), F. Matteazzi (1), A. Forcina
(1), L. Vago (1), M.T. Lupo Stanghellini (1), M. Bernardi (1),
J. Peccatori (1), A. Assanelli (1), M. Carrabba (1), F

Author address:

(1)San Raffaele Scientifi c Institute (Milan, IT); (2)San Raffaele
Scientifi c Institute; Vita-Salute San Raffaele University
(Milan, IT)

Full conference title:

Annual Meeting of the EBMT, 38th

Abstract:

Background: Febrile neutropenia and sepsis are frequent and
life-threatening complications in patients with hematological
malignancies. Blood cultures (BC) identify a pathogen in only
20 to 30% of febrile episodes, the culturing and pathogen identifi cation process is lengthy, postponing the start of a pathogentargeted treatment. Thereby a molecular tools able to promptly
recognize pathogens causing sepsis even despite ongoing
antimicrobial therapy is of potential clinical relevance.

Methods: We assessed the diagnostic usefulness of the LightCycler SeptiFast test (SF), a PCR-based multiplex assay which
can be performed on peripheral blood in hematological patients.
In this study, blood samples from febrile oncohaematological
patients were tested by traditional blood culture (BacT/Alert 3D;
bioMerieux) and by a novel commercial real-time PCR assay
(LightCycler SeptiFast; Roche Molecular Systems) performed
concomitantly at the onset of febrile neutropenia.
Results: A total of 869 blood samples were collected from 273
consecutive patients treated for febrile neutropenia at the San
Raffaele Hematology over the last three years. Out of the total
869 episodes examined, positive results were detected in 246
samples by SF (28.3%), and in 143 by BC (16.4%). Together,
the two methods identifi ed a total of 345 microorganisms in 312 S78
(36%) episodes: Gram-positive bacterial species (74%), Gramnegative bacterial species (23%), and fungal species (3%).
Concordance between the two methods was 73%, mainly due
to samples that tested negative by culture but positive using the
molecular approach (54% of the total positive samples). The
cases positive by SF alone were mostly samples from patients
with initial concordant results on samples harvested before the
administration of a specifi c antimicrobial therapy, or, importantly, sample positive for a clinically relevant agent such as
Aspergillus fumigatus, which is hard to detect by the traditional
approaches.
Conclusion: The LightCycler SeptiFast test gives new insights
into the natural history of infection and in the development of
new algorithms for the diagnosis of sepsis. Using SF combined
with BC improves microbiological documentation in febrile neutropenia particularly in persistent fever despite antibacterial therapy, when a nonresponding bacterial infection or an invasive
fungal infection is suspected; results of SF may lead to a more
targeted antibiotic therapy early after the onset of fever.

Abstract Number: O351

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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