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. 2022 Oct 29;16(3):494-500.
doi: 10.1093/ckj/sfac242. eCollection 2023 Mar.

Performance of real-time PCR in suspected haemodialysis catheter-related bloodstream infection: a proof-of-concept study

Mathieu Acquier  1 , Arnaud Zabala  2 , Valérie de Précigout  1 , Yahsou Delmas  1 , Véronique Dubois  3 , Renaud de la Faille  1 , Sébastien Rubin  1   4 , Christian Combe  1   5 , Fatima M'Zali  2 , Hannah Kaminski  1   6
Affiliations

Performance of real-time PCR in suspected haemodialysis catheter-related bloodstream infection: a proof-of-concept study

Mathieu Acquier et al. Clin Kidney J. .

Abstract

Background: Catheter-related bloodstream infections (CRBIs) remain a major cause of mortality in haemodialysis (HD) patients with central venous catheters (CVCs), especially because of the non-specific symptomatology and the delay in microbiological diagnosis with possible use of non-optimal empiric antibiotics. Moreover, empiric broad-spectrum antibiotics increase antibiotic resistance development. This study aims to evaluate the diagnostic performance of real-time polymerase chain reaction (rt-PCR) in suspected HD CRBIs compared with blood cultures.

Methods: A blood sample for rt-PCR was collected simultaneously with each pair of blood cultures for suspected HD CRBI. The rt-PCR was performed on the whole blood, without any enrichment stage and with specific DNA primers: 16S (universal bacterial), Staphylococcus spp., Staphylococcus aureus and mecA. Each successive patient with a suspected HD CRBI in the HD centre of Bordeaux University Hospital was included. Performance tests were used to compare the result obtained in each rt-PCR assay with its corresponding routine blood culture.

Results: Eighty-four paired samples were collected and compared for 40 suspected HD CRBI events in 37 patients. Among these, 13 (32.5%) were diagnosed as HD CRBI. All rt-PCRs except mecA (insufficient number of positive samples) showed high diagnostic performances within 3.5 h: 16S (sensitivity 100%, specificity 78%), Staphylococcus spp. (sensitivity 100%, specificity 97%), S. aureus (sensitivity 100%, specificity 99%). Based on the rt-PCR results, antibiotics could be more appropriately targeted, thus cutting anti-cocci Gram-positive therapy from 77% to 29%.

Conclusions: The performance of rt-PCR in suspected HD CRBI events showed fast and high diagnostic accuracy. Its use would improve HD CRBI management with an antibiotic consumption decrease.

Keywords: bloodstream infection; haemodialysis; real-time PCR.

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