Septifast and blood culture for identification of bloodstream pathogens in patients with Cystic Fibrosis during febrile infective exacerbation

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Septifast and blood culture for identification of bloodstream pathogens in patients with Cystic Fibrosis during febrile infective exacerbation
J Grosse-Onnebrink (1), J Steinmann (2), F Stehling (1), E Tschiedel (3), M Olivier (1), PM Rath (2), U Mellies (1)

(1) University Hospital Pediatric Pneumology - Essen (Germany)

(2) University Hospital Institute of Medical Microbiology - Essen (Germany)

(3) University Hospital Department of Pediatrics - Essen (Germany)
Blood culture (BC) is the gold standard for diagnosis of blood stream infections (BSIs). However, in patients with cystic fibrosis (CF) BSIs are rarely diagnosed. Whether by a multiplex real-time polymerase chain reaction assay like SeptiFast (SF) bloodstream pathogens are found more frequently than by BC has not been determined yet. Aim of this study was to compare the results of BC and SF in patients with CF during febrile infective exacerbation.
This retrospective study was conducted between December 2009 and October 2010 in patients with CF (age 12-38) who were hospitalized for febrile infective exacerbation. We obtained one blood sample for BC and SF (LightCycler® SeptiFast® Test (Roche Diagnostics, Mannheim, Germany)) prior to initiation of antibiotic treatment. Baseline characteristics, inflammatory biomarkers and impact on clinical management were determined by chart review.
49 episodes from 18 patients were eligible for analysis. The number of positivity was 8 (16.3%) for SF and 4 (8.2%) for BC. SF has detected 3 cases of candida albicans, 2 cases of pseudomonas aeruginosa and one case each of stenotrophomonas maltophilia, klebsiella pneumoniae and enterobacter cloacae. BC has identified two cases each of candida albicans and staphylococcus epidermidis. 39 (79.6%) tests were concordantly negative, 2 (4.0%) were concordantly positive, 6 (12.2%) were SF positive only and 2 (4.0%) were BC positive only. We did not find any significant correlation between positivity of SF and baseline characteristics or inflammatory biomarkers (white blood count, C-reactive protein, procalcitonin, immunoglobulin G, fibrinogen). Two results of SF accounted for an adjustment of treatment: a catheter associated sepsis by candida albicans led to early initiation of therapy with fluconazole. In another case due to the detection of stenotrophomonas maltophilia trimethoprim/sulfamethoxazole was added to the antibiotic treatment. The results of SF and BC were considered as contamination in 2 cases each.
In CF during febrile infective exacerbation SF detects more frequently bloodstream pathogens than BC. In cases of suspected catheter associated BSI the results of SF can lead to earlier initiation of adequate treatment. The clinical context must be considered for the interpretation of SF and BC results. Whether the use of SF is of general advantage in CF should be assessed in future clinical trials.
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