Abstract
Background
Skin and soft tissue infections have a high disease burden in children. The emergence of multidrug-resistant bacteria over the last decades has heavily influenced hospitalization rates, morbidity and mortality. In addition, with increased survival rates in neonatology and oncology, health-care associated infections are more frequently encountered. There is a growing need for fast and feasible diagnostic tools for the recognition of microorganisms and drug resistances.
Methods
In this prospective study, we compared results of routine culture with the multiplex PCR based Unyvero Implant and Tissue Infection (ITI) application. Specimens were obtained from different sources from neonates and children.
Results
We analyzed specimens from 29 patients (72.4% male) with a median age of 8.1 years (range 0.03–15.2). Concordance between Unyvero ITI and culture was reached in 16 of 29 samples (55.2%). Unyvero ITI yielded an overall sensitivity and specificity of 76.3% and 96.5%, respectively. Accuracies were best for non-fermenting bacteria, for which sensitivity was 100% and specificity 98.2%. Detection rates were lower for Gram-positive bacteria (68.8 and 95.2%, respectively). Unyvero correctly detected one blaOXA−24/40 producing Acinetobacter baumannii, while none of the six gyrA87 had a correlate in antimicrobial susceptibility testing.
Conclusions
Unyvero ITI quickly provides additional information relevant for clinical decision-makers. Sensitivity of the PCR must be improved especially for Gram-positive bacteria, and further studies are needed to assess the impact on clinical decision-making and outcome.
Similar content being viewed by others
Abbreviations
- AST:
-
Antimicrobial susceptibility testing
- CI:
-
Confidence interval
- CN:
-
Concordantly negative
- CNS:
-
Coagulase negative Staphylococci
- CP:
-
Concordantly positive
- ITI:
-
Implant and tissue infection
- MRSA:
-
Methicillin-resistant Staphylococcus aureus
- NPV:
-
Negative predictive value
- PCR:
-
Polymerase chain reaction
- PJI:
-
Prosthetic joint infection
- PPV:
-
Positive predictive value
- SSTI:
-
Skin and soft tissue infection
- UN:
-
Unyvero negative
- UP:
-
Unyvero positive
References
Esposito S, Noviello S, Leone S. Epidemiology and microbiology of skin and soft tissue infections. Curr Opin Infect Dis. 2016;29:109–15.
Sanders JE, Garcia SE. Evidence-based management of skin and soft-tissue infections in pediatric patients in the emergency department. Pediatr Emerg Med Pract. 2015;12:1–23. (quiz 23–24)
Pallin DJ, Egan DJ, Pelletier AJ, Espinola JA, Hooper DC, Camargo CA. Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus. Anna Emerg Med. 2008;51:291–8.
Edelsberg J, Taneja C, Zervos M, Haque N, Moore C, Reyes K, Spalding J, Jiang J, Oster G. Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis. 2009;15:1516–8.
Zingg W, Hopkins S, Gayet-Ageron A, Holmes A, Sharland M, Suetens C. Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey. Lancet Infect Dis. 2017;17:381–9.
Crivaro V, Bogdanovic L, Bagattini M, Iula VD, Catania M, Raimondi F, Triassi M, Zarrilli R. Surveillance of healthcare-associated infections in a neonatal intensive care unit in Italy during 2006–2010. BMC Infect Dis. 2015;15:152.
Borde JP, Hacker GA, Guschl S, Serr A, Danner T, Hubner J, Burrack-Lange S, Ludke G, Helwig P, Hauschild O, et al. Diagnosis of prosthetic joint infections using UMD-Universal Kit and the automated multiplex-PCR Unyvero i60 ITI((R)) cartridge system: a pilot study. Infection. 2015;43:551–60.
Hischebeth GT, Randau TM, Buhr JK, Wimmer MD, Hoerauf A, Molitor E, Bekeredjian-Ding I, Gravius S. Unyvero i60 implant and tissue infection (ITI) multiplex PCR system in diagnosing periprosthetic joint infection. J Microbiol Methods. 2016;121:27–32.
Prieto-Borja L, Rodriguez-Sevilla G, Aunon A, Perez-Jorge C, Sandoval E, Garcia-Canete J, Gadea I, Fernandez-Roblas R, Blanco A, Esteban J. Evaluation of a commercial multiplex PCR (Unyvero i60(R)) designed for the diagnosis of bone and joint infections using prosthetic-joint sonication. Enferm Infecc Microbiol Clin 2017;35:236–242
Jorgensen JH, Pfaller MA, Carroll KC, Funke G, Landry ML, Richter SS, Warnock DW. Manual of Clinical Microbiology. Canada: ASM Press; 2015.
Papan C, Meyer-Buehn M, Laniado G, Nicolai T, Griese M, Huebner J. Assessment of the multiplex PCR-based assay Unyvero pneumonia application for detection of bacterial pathogens and antibiotic resistance genes in children and neonates. Infection. 2018;46:189–96.
Schulte B, Eickmeyer H, Heininger A, Juretzek S, Karrasch M, Denis O, Roisin S, Pletz MW, Klein M, Barth S, et al. Detection of pneumonia associated pathogens using a prototype multiplexed pneumonia test in hospitalized patients with severe pneumonia. PloS One. 2014;9:e110566.
Kunze N, Moerer O, Steinmetz N, Schulze MH, Quintel M, Perl T. Point-of-care multiplex PCR promises short turnaround times for microbial testing in hospital-acquired pneumonia–an observational pilot study in critical ill patients. Ann Clin Microbiol Antimicrob. 2015;14:33.
Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med. 1998;17:857–72.
Wilson EB. Probable Inference, the Law of Succession, and Statistical Inference. J Am Stat Assoc. 1927;22:209–12.
Acree ME, Morgan E, David MZ. S. aureus infections in Chicago, 2006–2014: increase in CA MSSA and decrease in MRSA incidence. Infect Control Hospital Epidemiol. 2017;38:1226–34.
Riboli DF, Lyra JC, Silva EP, Valadao LL, Bentlin MR, Corrente JE, Rugolo LM, da Cunha Mde L. Diagnostic accuracy of semi-quantitative and quantitative culture techniques for the diagnosis of catheter-related infections in newborns and molecular typing of isolated microorganisms. BMC Infect Dise. 2014;14:283.
Larru B, Gerber JS. Cutaneous bacterial infections caused by Staphylococcus aureus and Streptococcus pyogenes in infants and children. Pediatr Clin N Am. 2014;61:457–78.
Mariaux S, Tafin UF, Borens O. Diagnosis of persistent infection in prosthetic two-stage exchange: PCR analysis of sonication fluid from bone cement spacers. J Bone Jt Infect. 2017;2:218–23.
Villa F, Toscano M, De Vecchi E, Bortolin M, Drago L. Reliability of a multiplex PCR system for diagnosis of early and late prosthetic joint infections before and after broth enrichment. Int J Med Microbiol. 2017;307:363–70.
Malandain D, Bemer P, Leroy AG, Leger J, Plouzeau C, Valentin AS, Jolivet-Gougeon A, Tande D, Hery-Arnaud G, Lemarie C, et al. Assessment of the automated multiplex-PCR Unyvero i60 ITI((R)) cartridge system to diagnose prosthetic joint infection: a multicentre study. Clin Microbiol Infect. 2018;24:83.e81–83.e86.
Principi N, Esposito S. Kingella kingae infections in children. BMC Infect Dis. 2015;15:260.
Papan C, von Both U, Kappler M, Kammer B, Griese M, Huebner J. Pott’s disease: a major issue for an unaccompanied refugee minor. Thorax. 2017;72:282–3.
Personne Y, Ozongwu C, Platt G, Basurto-Lozada P, Shamin M, Gant VA, Zumla A, Enne VI. ‘Sample-in, answer-out’? Evaluation and comprehensive analysis of the Unyvero P50 pneumonia assay. Diagn Microbiol Infect Dise. 2016;86:5–10.
Jamal W, Al Roomi E, AbdulAziz LR, Rotimi VO. Evaluation of Curetis Unyvero, a multiplex PCR-based testing system, for rapid detection of bacteria and antibiotic resistance and impact of the assay on management of severe nosocomial pneumonia. J Clin Microbiol. 2014;52:2487–92.
Ozongwu C, Personne Y, Platt G, Jeanes C, Aydin S, Kozato N, Gant V, O’Grady J, Enne VI. The Unyvero P55 ‘sample-in, answer-out’ pneumonia assay: a performance evaluation. Biomol Detect Quantif. 2017;13:1–6.
Acknowledgements
We would like to thank Hannelore Zeilhofer, Petra Aydin, Petra Kappel, and Birgit Hanings for excellent technical assistance. Curetis GmbH (Holzgerlingen, Germany) provided the Unyvero system, cartridges, and technical support, but had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Funding
This work received no specific grant from any funding agency.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interests.
Ethical statement
This prospective and observational study was reviewed, approved, and declared unobjectionable by the ethic committee of the Ludwig-Maximilians-Universität München (UE Nr. 012–14). The need for informed consent was waived since no additional patient samples were obtained.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Papan, C., Meyer-Buehn, M., Laniado, G. et al. Evaluation of the multiplex PCR based assay Unyvero implant and tissue infection application for pathogen and antibiotic resistance gene detection in children and neonates. Infection 47, 195–200 (2019). https://doi.org/10.1007/s15010-018-1192-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-018-1192-7