The effect of empiric antimicrobial treatment duration on detection of bacterial DNA in sterile surgical specimens

Initial antimicrobial treatment of patients with deep seated or invasive infections is typically empiric. Usually, cultures of specimens obtained from the suspected source of infection are performed to identify pathogens and guide continued antimicrobial treatment. When patients present with signs a...

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Bibliographic Details
Published in:PloS one 2017-02, Vol.12 (2), p.e0171074-e0171074
Main Authors: Farrell, John Joseph, Wang, Huaping, Sampath, Rangarajan, Lowery, Kristin S, Bonomo, Robert A
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Anti-infective agents
Antibiotics
Antiinfectives and antibacterials
Antimicrobial agents
Bacteria
Bacteria - drug effects
Bacteria - genetics
Bacterial Infections - drug therapy
Bacterial Infections - microbiology
Bacterial Infections - surgery
Bacterial Load
Biology and Life Sciences
Blood
Body fluids
Computational fluid dynamics
Cultures (Biology)
Deoxyribonucleic acid
Diagnosis
Diagnostic systems
DNA
DNA, Bacterial
Dosage and administration
Drug therapy
Enrollments
Female
Fluid
Fluids
Genetic testing
Humans
Infections
Ionization
Laboratories
Male
Mass spectrometry
Mass spectroscopy
Medicine
Medicine and Health Sciences
Microbiology
Middle Aged
Odds Ratio
Pathogens
Patients
Physicians
Polymerase Chain Reaction
Research and Analysis Methods
Scientific imaging
Sepsis
Signs and symptoms
Spectrometry, Mass, Electrospray Ionization
Surgery
Tissues
Treatment Outcome
Young Adult
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Summary:Initial antimicrobial treatment of patients with deep seated or invasive infections is typically empiric. Usually, cultures of specimens obtained from the suspected source of infection are performed to identify pathogens and guide continued antimicrobial treatment. When patients present with signs and symptoms of infection, but sterile body fluid or tissue specimens cannot be obtained in a timely fashion, growth of bacterial pathogens in culture may be inhibited following initiation of empiric antibiotic treatment. To address this clinical dilemma, we performed a prospective evaluation of conventional culture vs. PCR coupled to electrospray ionization mass spectrometry (PCR/ESI-MS) on sterile body fluids and tissues submitted to the diagnostic microbiology lab following initiation of empiric antibiotic treatment for patients with suspected infection. In this series of surgical samples, PCR/ESI-MS identified bacterial pathogen(s) in 56% (49/87) of patients with non-diagnostic cultures. Examination of patients stratified by antibiotic treatment duration demonstrated that PCR/ESI-MS sustains high rates of bacterial DNA detection over time by generalized estimating equation models (p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0171074