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Journal of Clinical Microbiology, August 2009, p. 2405-2410, Vol. 47, No. 8
0095-1137/09/$08.00+0 doi:10.1128/JCM.00491-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
Utility of a Commercially Available Multiplex Real-Time PCR Assay To Detect Bacterial and Fungal Pathogens in Febrile Neutropenia 
Marie von Lilienfeld-Toal,1,2,
*
Lutz E. Lehmann,3,
Ansgar D. Raadts,3
Corinna Hahn-Ast,1
Katjana S. Orlopp,1
Günter Marklein,4
Ingvill Purr,4
Gordon Cook,2
Andreas Hoeft,3
Axel Glasmacher,1 and
Frank Stüber5
Medizinische Klinik und Poliklinik III, Universitätsklinikum Bonn, Bonn, Germany,1 Bone Marrow Transplant Unit, St. James's University Hospital, Leeds, United Kingdom,2 Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Germany,3 Institut für Medizinische Mikrobiologie, Immunologie und Parasitologie, Universitätsklinikum Bonn, Bonn, Germany,4 Department of Anaesthesiology and Pain Therapy, University Hospital Bern, 3010 Bern, Switzerland5
Received 10 March 2009/ Returned for modification 26 May 2009/ Accepted 11 June 2009
Infection is the main treatment-related cause of mortality in cancer patients. Rapid and accurate diagnosis to facilitate specific therapy of febrile neutropenia is therefore urgently warranted. Here, we evaluated a commercial PCR-based kit to detect the DNA of 20 different pathogens (SeptiFast) in the setting of febrile neutropenia after chemotherapy. Seven hundred eighty-four serum samples of 119 febrile neutropenic episodes (FNEs) in 70 patients with hematological malignancies were analyzed and compared with clinical, microbiological, and biochemical findings. In the antibiotic-naïve setting, bacteremia was diagnosed in 34 FNEs and 11 of them yielded the same result in the PCR. Seventy-three FNEs were negative in both systems, leading to an overall agreement in 84 of 119 FNEs (71%). During antibiotic therapy, positivity in blood culture occurred only in 3% of cases, but the PCR yielded a positive result in 15% of cases. In six cases the PCR during antibiotic treatment detected a new pathogen repetitively; this was accompanied by a significant rise in procalcitonin levels, suggestive of a true detection of infection. All patients with probable invasive fungal infection (IFI; n = 3) according to the standards of the European Organization for Research and Treatment of Cancer had a positive PCR result for Aspergillus fumigatus; in contrast there was only one positive result for Aspergillus fumigatus in an episode without signs and symptoms of IFI. Our results demonstrate that the SeptiFast kit cannot replace blood cultures in the diagnostic workup of FNEs. However, it might be helpful in situations where blood cultures remain negative (e.g., during antimicrobial therapy or in IFI).
* Corresponding author. Mailing address: Med. Klinik und Poliklinik III, Universitätsklinikum Bonn, Sigmund Freud Str. 25, 53105 Bonn, Germany. Phone and fax: 49-228-28714003. E-mail: m.lilienfeld.toal{at}uni-bonn.de
Published ahead of print on 1 July 2009.
These authors contributed equally to the paper.
Journal of Clinical Microbiology, August 2009, p. 2405-2410, Vol. 47, No. 8
0095-1137/09/$08.00+0 doi:10.1128/JCM.00491-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.
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