Microbiologia Medica (Dec 2015)

Emergency management in bacterial meningitis and sepsis: application of real time-polymerase chain reaction and FilmArray technology performed directly on cerebrospinal fluid and blood samples

  • Loria Bianchi,
  • Zaleida Napoli,
  • Swan Donati,
  • Patrizia Lencioni,
  • Fabiano Santoni,
  • Riccardo Lari

DOI
https://doi.org/10.4081/mm.2015.5084
Journal volume & issue
Vol. 30, no. 2

Abstract

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Background and Aims. Bacterial meningitis and sepsis are medical emergencies where tests with a high sensitivity and short turn around time (TAT) are crucial for an early targeted therapy. Aim of this study was the evaluation of an optimal diagnostic strategy for infectious meningitis/sepsis management, assessing seven methods: cerebrospinal fluid (CSF) physical-chemical examination, CSF cultural tests (CCT), Gram stained smears (GSS), CSF latex agglutination test (CLAT), blood culture (BC), Real-Time (RT)-PCR and FilmArray Technology (FAT) performed directly on CSF/blood. Materials and Methods. Samples of CSF (240), blood (180) and cavitary fluids (9) were tested by commercial RT-PCR (Eurospital and Liferiver kits) and traditional methods. Positive samples (BC and RT-PCR) were tested by FAT (Blood Culture Identification Panel, Biofire, Salt Lake City, UT, USA) performed directly on CSF, blood and cavitary fluids. Results. In CSF, GSS, CLAT, CCT, RT-PCR and FAT sensitivity was 41%, 35%, 41%, 100% and 62,5%, respectively. In blood, BC, RT-PCR and FAT sensitivity was 96%, 70% and 44%, respectively. TAT was 48-96 hrs, 3 hrs and 1 hr and NPV was 98%, 89% and 57%, respectively. Conclusions. For sepsis management, RT-PCR is faster than BC (3 hrs vs 24-72 hrs), but limited by a low overall sensitivity (70%), due to the low number of detectable pathogens; FAT, performed directly on positive BC should replace biochemical identification (Vitek 2, Biomérieux Marcy-l’Étoile, France) reducing TAT (1 hr vs 12 hrs). For meningitis management, RT-PCR is the most sensitive and rapid method used in routine and emergency regimen. It is cost effective and it represents the gold standard for diagnosis and follow-up of patients under treatment. For meningitis management, FAT, with a higher sensitivity and rapidity and an easier and objective interpretation, should replace CLAT and GSS in emergency regimen.

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