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. 2019 Jan 7;68(2):266-272.
doi: 10.1093/cid/ciy472.

Etiology of Sepsis in Uganda Using a Quantitative Polymerase Chain Reaction-based TaqMan Array Card

Christopher C Moore  1 , Shevin T Jacob  2 , Patrick Banura  3 , Jixian Zhang  1 , Suzanne Stroup  1 , David R Boulware  4 , W Michael Scheld  1 , Eric R Houpt  1 , Jie Liu  1
Affiliations

Etiology of Sepsis in Uganda Using a Quantitative Polymerase Chain Reaction-based TaqMan Array Card

Christopher C Moore et al. Clin Infect Dis. .

Abstract

Background: Knowledge of causes of sepsis in sub-Saharan Africa is limited. A better understanding of the microbiology of bloodstream infections could improve outcomes.

Methods: We used a quantitative polymerase chain reaction (qPCR)-based TaqMan Array Card (TAC) to directly test for 43 targets from whole blood. We analyzed 336 cryopreserved specimens from adult Ugandans with sepsis enrolled in a multisite study; 84% were infected with human immunodeficiency virus. We compared qPCR TAC results with blood culture and determined the association of qPCR with study participant outcomes using logistic regression.

Results: The most frequently detected targets were cytomegalovirus (CMV, n = 139, 41%), Mycobacterium tuberculosis (TB, n = 70, 21%), Plasmodium (n = 35, 10%), and Streptococcus pneumoniae (n = 31, 9%). Diagnostic performance varied by target with qPCR sensitivity averaging 61 ± 28% and specificity 98 ± 3% versus culture. In multivariable analysis, independent factors associated with in-hospital mortality included CMV viremia (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI], 1.8-5.5; p < .01) and TB qPCR-positivity, whether blood culture-positive (aOR 4.6, 95% CI, 2.1-10.0; p < .01) or blood culture-negative (aOR 2.9, 95% CI, 1.2-6.9; p = .02).

Conclusions: Using qPCR TAC on direct blood specimens, CMV and TB were the most commonly identified targets and were independently associated with increased in-hospital mortality. qPCR TAC screening of blood for multiple targets may be useful to guide triage and treatment of sepsis in sub-Saharan Africa.

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Figures

Figure 1.
Figure 1.
Association of CMV, Mycobacterium tuberculosis, Plasmodium, Streptococcus pneumoniae, and DNA quantity as determined by quantification cycle with mortality for 336 adult patients admitted to hospital with sepsis in Uganda. The x-axis shows the Cq ranges, whereas the y-axis shows the in-hospital mortality associated with each pathogen according to the corresponding Cq cutoff. The dark bar indicates the mortality rate for TAC negative patients for all the pathogens interrogated. Abbreviations: CMV, cytomegalovirus; Cq, quantification cycle; TAC, TaqMan Array Card.
See this image and copyright information in PMC

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