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| Year : 2017
| Volume
: 20 | Issue : 1 | Page
: 112-113 |
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| Nucleic acid-based methods for early detection of sepsis |
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Sarvesh Pal Singh
Department of CTVS, CT Center, AIIMS, New Delhi, India
Click here for correspondence address and
email
| Date of Web Publication | 6-Jan-2017 |
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How to cite this article:
Singh SP. Nucleic acid-based methods for early detection of sepsis. Ann Card Anaesth 2017;20:112-3 |
The Editor,
The primary determinant of survival in patients that develop sepsis is the time for recognition of infection and initiation of antibiotics. [1] The culture of an organism, still the gold standard, takes nearly 48-72 h to grow and test the antibiotic susceptibility of organism by conventional methods. [2] Nucleic acid-based methods give results within 6-12 h and are also available for commercial use. In a broad sense, all pathogenic organisms have a unique internal genomic sequence which can be amplified using primers of DNA or RNA and later cross-referenced with the available signatures in the database to identify the genus or species of the microorganism present in a sample. Following tests can be applied on the whole-blood samples and are available commercially:
- SepsiTest (Molzym, Bremen, Germany): Uses broad range polymerase chain reaction (PCR) to amplify the species specific internal regions in the genome of a pathogen. If found positive, these amplicons are subject to sequence analysis to identify the microorganism. The broad range binding of primers to 16s and 18s ribosomal RNA allows detection of more than 345 pathogens by SepsiTest. [3] In India, it is being used in the name of SepsiScreen (SRL Lab) [4]
- Lightcycler SeptiFast test (Roche Molecular Systems, Branchburg, NJ, USA): Uses multiplex real-time PCR technology to identify internal transcribed spacer region and distinguishes 25 different species of bacteria and fungi, including Staphylococcus, Streptococcus, Enterococcus, Enterobacter, Pseudomonas, Acinetobacter, Klebsiella, Escherichia coli, Proteus, Serratia, Candida spp., and Aspergillus fumigatus. It takes up to 6 h for a final report and is approved for use in Europe. It is one of the most extensively used sepsis screen tests [3],[5]
- Vyoo (SIRS-Lab, Jena, Germany): Uses multiplex PCR technology with subsequent gel electrophoresis. Vyoo can detect 34 bacteria, 7 fungi, and 5 antibiotic resistance genes in about 7 h. In addition to the organisms detected by SeptiFast, it also detects Clostridium, Haemophilus, Neisseria, and Prevotella spp [3],[6]
- Magicplex sepsis test (Seegene, Korea): Magicplex also uses multiplex PCR technology to detect ninety sepsis causing pathogens in 3 h after DNA extraction. Seventy gram positive, 12 gram negative, and six types of fungi may be identified using this test. It also detects three genes for antibiotic resistance [7]
- IRIDICA (Abbott Laboratories, USA): IRIDICA uses a combination of two technologies - PCR and electrospray ionization mass spectrometry (PCR/ESI-MS). In addition to the 16srRNA gene, the PCR/ESI-MS targets the 23s RNA polymerase and other genes for bacterial detection and quantification. IRIDICA currently has five panels - sepsis, bacterial, fungal, and viral infections, and ventilator-associated pneumonia. It can identify more than 1000 pathogens in 6 h, including more than 750 bacteria and 200 fungi. [8]
False positive results from nucleic acid base tests are due to contamination of samples and a low organism load in the sample can lead to false negative results. Therefore, newer versions of some tests recommend increasing the sample volume from 1 to 5 ml. Although nucleic acid-based tests are highly sensitive, the results should be inferred with respect to the patient's clinical condition and not in isolation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Kumar A, Ellis P, Arabi Y, Roberts D, Light B, Parrillo JE, et al. Initiation of inappropriate antimicrobial therapy results in a fivefold reduction of survival in human septic shock. Chest 2009;136:1237-48.  |
| 2. | Weinstein MP. Blood culture contamination: Persisting problems and partial progress. J Clin Microbiol 2003;41:2275-8. |
| 3. | Mancini N, Carletti S, Ghidoli N, Cichero P, Burioni R, Clementi M. The era of molecular and other non-culture-based methods in diagnosis of sepsis. Clin Microbiol Rev 2010;23:235-51. |
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| 5. | Ziegler I, Josefson P, Olcén P, Mölling P, Strålin K. Quantitative data from the SeptiFast real-time PCR is associated with disease severity in patients with sepsis. BMC Infect Dis 2014;14:155. |
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| 8. | Jordana-Lluch E, Giménez M, Quesada MD, Rivaya B, Marcó C, Domínguez MJ, et al. Evaluation of the broad-range PCR/ESI-MS technology in blood specimens for the molecular diagnosis of bloodstream infections. PLoS One 2015;10:e0140865. |
Correspondence Address:
Sarvesh Pal Singh
Department of CTVS, CT Center, AIIMS, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-9784.197850
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