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Am J Perinatol 2024; 41(05): 569-574
DOI: 10.1055/s-0042-1742743
Original Article

Use of Rapid Molecular Polymerase Chain Reaction in Early Detection of Bacteremia in Neonates Prior to Blood Culture Positivity: A Pilot Study

Beri Massa-Buck
1   Department of Neonatology, Children's National Hospital, Washington, District of Columbia
2   Division of Newborn Services, The George Washington University Hospital, Washington, District of Columbia
,
Salome Mendoza
3   Department of Pathology, The George Washington University Hospital, Washington, District of Columbia
,
John Keiser
3   Department of Pathology, The George Washington University Hospital, Washington, District of Columbia
,
Mohamed A. Mohamed 
4   Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
› Author Affiliations
Funding Reagent kits for the FilmArray assay for this study were provided by BioFire Diagnostics (Salt Lake City, UT). No other funding was secured for this study. Role of Funder/Sponsor: BioFire Diagnostics (Salt Lake City, UT) had no role in the design and conduct of the study. BioFire Diagnostics provided reagent kits for this study.
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Abstract

Objective There has been national strive to decrease the time needed to identify microorganisms in blood culture samples to reduce antibiotic use. This study evaluated rapid molecular polymerase chain reaction (PCR) use in identifying microorganisms in negative culture bottles from neonates with suspected bacterial blood stream infection at 20 to 24 hours of incubation.

Study Design All blood specimens from neonates with suspected blood stream infection were included. Specimens were incubated using a standard blood culturing instrument that would flag positive if bacterial growth was detected. If the specimen was flagged positive at <20 hours, it was tested by PCR and plated for identification as per standard protocol. In our design, if specimen was not flagged at 20 hours of incubation, the bottle was sterilely accessed and a sample was obtained for PCR testing. The bottle would be returned for incubation for 120 hours or until flagged positive.

Results A total of 192 blood specimens were included. Four specimens flagged positive at <20 hours and were all found to be positive by PCR. All other samples did not flag positive by 20 hours of incubation and were tested by PCR between 20 and 24 hours. One sample tested positive via PCR at 21.6 hours then flagged positive on the culturing instrument at 23.5 hours. All other specimens were negative by PCR and remained culture negative at 120 hours. The positive and negative predictive value of PCR verified by blood culture were both equal to 1.0.

Conclusion Using rapid molecular PCR on blood culture specimens at 20 to 24 hours of incubation provides 100% true negative results possibly allowing providers to discontinue antibiotics at 24 hours.

Key Points

  • Antibiotic overuse leads to adverse neonatal outcomes.

  • Molecular PCR may have true negative results.

  • Larger study is needed to discontinue antibiotics earlier.

Keywords

rapid molecular PCR - neonatal bacteremia - neonatal sepsis - pediatric blood culture

Note

Deidentified individual participant data will not be made available.


Authors' Contribution

B.M.-B. conceptualized and designed the study, collected data, performed the initial data analyses, drafted/reviewed, and revised the manuscript. M.A.M. conceptualized and designed the study, performed the initial and final analyses, drafted/reviewed, and revised the manuscript. S.M. coordinated and supervised the technical aspect of the study in the microbiology laboratory, collected data, and critically reviewed and edited the manuscript for intellectual content. J.K. conceptualized and designed the study and critically reviewed and edited the manuscript for intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.




Publication History

Received: 09 September 2021

Accepted: 12 January 2022

Article published online:
11 February 2022

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