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Clinical utility of Septifast PCR in neutropenic cancer patients with persistent fever despite antibacterial therapy

Abstract number: O36

Lamoth F., Jaton-Ogay K., Bille J., Prodhom G., Senn L., Calandra T., Marchetti O.

Background: Blood cultures are the standard technique for the microbiological documentation of fever during neutropenia. However, no pathogen is identified in the majority of patients with persistent fever despite broad-spectrum antibacterial therapy. This results in multiple investigations and empirical modifications of antimicrobial therapy. Septifast (Roche) is a new PCR test for the detection of bacterial and fungal DNA in blood.

Objective: To assess the clinical utility of Septifast in neutropenic cancer patients with persistent fever despite antibacterial therapy.

Method: 48 consecutive adult neutropenic patients with persistent fever during geqslant R: gt-or-equal, slanted3 days after myeloablative chemotherapy for hematogical malignancies were studied. Febrile episodes were classified as microbiologically (MDI) or clinically documented infection (CDI) and fever of unknown origin (FUO) (ICHS, JID, 1990). Blood cultures were performed on D0 (onset of fever) and D3 (persistent fever). Blood samples for Septifast were drawn on D3. Septifast results were compared with microbiological and clinical documentation of infection.

Results: 53 episodes of persistent fever were analysed (20 MDI, 22 CDI, 11 FUO). Blood cultures detected pathogens in 11/53 (21%) episodes on D0. On D3, blood cultures and Septifast were positive in 4/53 (8%) episodes and 20/53 (38%; p < 0.001), respectively. Septifast detected 4 pathogens identified by blood cultures (D0 or D3). In addition, 21 bacterial pathogens (7 G+, 14 G-) were detected by SF only (86% with documented site of infection): these results are summarised in the Table.

6 fungi were detected by Septifast, none by blood cultures. 5 of these positive results were observed in possible or probable invasive mycoses (EORTC-MSG criteria, CID, 2001).

Conclusions: Septifast PCR is clinically useful in neutropenic cancer patients with persistent fever despite antibacterial therapy.

Bacteria detected by Septifast only (D3)

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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