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Catheter-associated bloodstream infection (CRBI) is the leading cause
of death in patients on hemodialysis (HD) with central venous catheters (CVCs).
The clinical features of these infections are complex and challenging to identify and treat
.
At present, blood culture is the gold standard for CRBI diagnosis, but in actual clinical work, blood culture takes a long time, which will cause patients to miss the best antibacterial treatment time
.
In addition, the efficacy of empiric antimicrobial therapy for CRBI was not significant
.
So, is there a way to quickly predict the pathogen of HD CRBI?
On October 29, 2022, CKJ published a study from France that found that real-time C-reactive protein levels (rt-PCR) were associated with CRBI infection, and that C-reactive protein levels also predicted the microorganisms
that cause CRBI.
In short, the application of rt-PCR technology will optimize the care
of HD patients while blood cultures are still the gold standard for HD.
Study design
This is a single-center, descriptive, transversal prospective clinical study to evaluate the efficacy
of rt-PCR for the diagnosis of CRBI compared to blood culture diagnostics.
The enrolled patients were all HD patients
over the age of 18 with suspected CRBI.
Patients receiving antimicrobial therapy for more than 8 hours were not included in the study
.
Blood samples were collected from each patient with suspected HD CRBI, along with rt-PCR and blood cultures
.
Of note, rt-PCR detection is performed in whole blood without enrichment, using specific DNA primers, such as 16s primers for all bacteria, Staphylococcus and Staphylococcus aureus as their unique primers, and mecA
for methicillin-resistant bacteria.
of RT-PCR to detect all bacteria, staphylococcus, Staphylococcus aureus, and methicillin-resistant bacteria compared to blood culture tests.
Study results
A total of 37 patients were enrolled, a total of 40 suspected HD CRBI events were enrolled, 3 patients had 2 suspected HD CRBI events, and a total of 84 blood samples
were collected.
Of the 84 samples, 27 (32%) had positive blood cultures
.
Of the 40 suspected HD CRBI events, 23 (55.
5%) had at least one positive
blood culture for suspected HD CRBI events.
After excluding false positives (such as contamination) and urinary tract infections, 13 patients (32.
5%) were diagnosed with HD CRBI
.
Of the 13 patients with HD CRBI, 12 were associated with CVC infection and 1 with non-CVC infection
.
In this study, the average time required for rt-PCR detection was 3.
5h (IQR: 3h10min~3h50min), and the average time required for blood culture detection was 12h (IQR: 9.
75~21h).
Obviously, RT-PCR takes less
time.
Overall, rt-PCR tests have higher sensitivity, specificity, and Kappa coefficients for all bacteria, staphylococci, and Staphylococcus aureus compared with blood culture tests due to the low positive results of methicillin-resistant bacteria in the samples (n = 1) and other than those in the table below (Table 1).
Table 1 Detection capabilities of rt-PCR
Discussion and Summary
It is reported that this is the first time in suspected HD
A clinical study
to verify the accuracy of RT-PCR detection in the patient population of CRBI.
The study found that the RT-PCR test was highly accurate and could effectively and accurately predict staphylococcal and Staphylococcus aureus infections
.
However, for all bacteria, perhaps the 16s primers are too sensitive, resulting in lower specificity of the 16s primers
.
The researchers believe that other primers that are tested for all bacteria may have the right sensitivity
.
More importantly, rt-PCR detection does not require enrichment and the detection time is short
.
Overall, rt-PCR tests have a high level of accuracy and can help physicians identify infecting organisms relatively quickly to develop effective antimicrobial regimens
that can be used as an alternative to empiric therapy.
This will help to rapidly control the symptoms of infection in HD CRBI patients, benefiting the patient's eventual prognosis
.
References:
1.
Mathieu Acquier, Arnaud
zabala,Valérie
de Précigout, et al.
Performance of real-time PCR in suspected hemodialysis
catheter-related bloodstream infection, a proof-of-concept study.
CKJ.
Sfac242.
Oct 29, 2022.
