Multiplex qPCR for the early detection of sepsis pathogens and its impact on antimicrobial therapy in critically ill patients

Pooja  Pandey; Raunak  Bir; Kuhu  Chatterjee; Nikhil  Verma; Yasha  Mukim; Komal  Grover; Shefali  Sharma; Priya  Sehgal; Swati  Chamoli; Rajiv M  Gupta; Anil K  Pandey

doi:10.18502/ijm.v18i3.21654

Pooja Pandey Department of Microbiology, ESIC Medical College & Hospital, Faridabad, Haryana, India
Raunak Bir Department of Microbiology, ESIC Medical College & Hospital, Faridabad, Haryana, India
Kuhu Chatterjee Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
Nikhil Verma Department of Medicine, ESIC Medical College & Hospital, Faridabad, Haryana, India
Yasha Mukim Department of Microbiology, ESIC Medical College & Hospital, Faridabad, Haryana, India
Komal Grover Department of Microbiology, ESIC Medical College & Hospital, Faridabad, Haryana, India
Shefali Sharma Department of Microbiology, ESIC Medical College & Hospital, Faridabad, Haryana, India
Priya Sehgal Department of Microbiology, ESIC Medical College & Hospital, Faridabad, Haryana, India
Swati Chamoli Department of Microbiology, ESIC Medical College & Hospital, Faridabad, Haryana, India
Rajiv M Gupta Department of Microbiology, ESIC Medical College & Hospital, Faridabad, Haryana, India
Anil K Pandey Department of Physiology, ESIC Medical College & Hospital, Faridabad, Haryana, India

DOI: https://doi.org/10.18502/ijm.v18i3.21654

Keywords: Sequential organ failure assessment; Multiplex quantitative polymerase chain reaction; Sepsis; Procalcitonin

Abstract

Background and Objectives: Sepsis is a life threatening condition caused by a dysregulated host response to infection and is associated with high morbidity and mortality worldwide. Early bacterial detection and therapy with antibiotics improve outcomes. We compared multiplex quantitative PCR (qPCR) to traditional blood culture for early pathogen detection in critically ill patients with suspected sepsis.

Materials and Methods: This prospective observational study included 200 critically ill ICU patients with suspected sepsis. Multiplex qPCR using the TRUPCR® Sepsis Panel was compared with conventional blood culture for pathogen detection. To assess sensitivity, specificity, PPV, and NPV, blood culture was used as the reference standard. Mortality, ICU stay, and antibiotic therapy time were studied. Multivariable logistic regression was adjusted for baseline severity (SOFA, APACHE II), septic shock, and antibiotic exposure.

Results: Multiplex qPCR significantly reduced the time to initiation of appropriate antibiotic therapy (5.2 vs 8.3 hours, p<0.001). The assay demonstrated higher sensitivity compared with blood culture for pathogen detection. qPCR positivity was associated with shorter ICU stay and lower mortality; however, these associations were interpreted after adjustment for baseline illness severity. Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus were the most frequently de- tected pathogens, and several antimicrobial resistance genes including bla CTX-M NDM , and mecA were identified.

Conclusion: Multiplex qPCR can detect infections early and optimize antimicrobials for sepsis. These findings should be cautiously evaluated and corroborated in larger multicentre trials due to reduced specificity and observational nature.