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Molekularbiologischer Erregernachweis bei Patienten mit Sepsis

Möglichkeiten, Grenzen, Perspektiven

Molecular biological detection of pathogens in patients with sepsis

Potentials, limitations and perspectives

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Zusammenfassung

Das klinisch variable Erscheinungsbild und die fortbestehenden Schwierigkeiten beim zeitnahen sensitiven und spezifischen laboratoriumsmedizinischen Infektionsnachweis machen die Sepsis immer noch zu einer schwierigen und zumeist primär klinischen Diagnose. Zeitgemäße Diagnostikkonzepte für eine direkte Erregerdiagnose aus Vollblut auf der Basis qualitativer und quantitativer molekularbiologischer Detektionsmethoden werden daher vielfach als ein interessanter Ausweg angesehen, um dem Dilemma einer wenig sensitiven und zumeist relativ zeitintensiven mikrobiellen Erregerdiagnostik auf der Basis klassischer Kulturverfahren zu entgehen und der Notwendigkeit Rechnung zu tragen, bei septischen Patienten möglichst frühzeitig eine erregerorientierte zielgerichtete Antibiotikatherapie zu initiieren. Zudem legen erste klinische Studienergebnisse die mögliche zukünftige Bedeutung sensitiver kulturunabhängiger Verfahren mit kurzen „Turn-around“-Zeiten für effektivere Therapiemöglichkeiten und ein besseres Outcome von Patienten mit schweren Infektionen wie Sepsis und septischem Schock nahe. Zunächst sind molekularbiologische Nachweise allerdings trotz vieler Vorteile bei Geschwindigkeit und Sensitivität als komplementäre Verfahren zu sehen und werden klassische Testverfahren wie die Blutkultur auch unter finanziellen Gesichtspunkten in vielen Bereichen nicht kurzfristig ersetzen können. Es ist aber damit zu rechnen, dass analog zur rasanten Entwicklung in anderen Technologiefeldern, molekularbiologische Verfahren, die heute noch als kompliziert, arbeitsaufwendig und teuer gelten, in Zukunft den Standard der infektiologischen und mikrobiologischen Diagnostik prägen werden.

Abstract

The wide variability of clinical symptoms and the ongoing difficulties concerning the rapid and specific laboratory diagnosis of sepsis, contribute to the fact that sepsis primarily remains a clinical diagnosis. To contribute to a more tailored antibiotic coverage of the patient early on in the course of the disease, modern diagnostic concepts favour the qualitative and quantitative molecular biological detection of blood stream pathogens directly from whole blood. This offers a very attractive alternative to the currently applied less sensitive and much more time-consuming blood culture-based laboratory methods. Moreover, recent study results suggest an increasing impact of molecular detection methods with short turn-around times for more effective treatment and better outcomes of patients with sepsis and septic shock. In the short term, such tests will not substitute conventional blood culture despite their superior rapidity and sensitivity, mainly because of higher cost. The amazing speed of ongoing scientific developments means, however, that techniques that might appear complicated, labour intensive, and costly today, will develop to become the future standards in the microbiological diagnosis of patients with sepsis and septic shock.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Die Autoren haben an von der Fa. Roche Diagnostics, Penzberg, finanzierten Studien zur Evaluation und Zulassung PCR-gestützter Testsysteme (SeptiFast®) teilgenommen.

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  1. Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Klinikum der Johann Wolfgang Goethe-Universität, Paul-Ehrlich-Str. 40, 60596, Frankfurt/Main, Deutschland

    K.-P. Hunfeld MPH & V. Brade

  2. Zentrum für Anästhesiologie und Wiederbelebung, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt/Main, Deutschland

    T. Bingold & H. Wissing

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  1. K.-P. Hunfeld MPH
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Correspondence to K.-P. Hunfeld MPH.

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Hunfeld, KP., Bingold, T., Brade, V. et al. Molekularbiologischer Erregernachweis bei Patienten mit Sepsis. Anaesthesist 57, 326–337 (2008). https://doi.org/10.1007/s00101-008-1345-7

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