Development and Clinical Validation of a Droplet Digital PCR Method for
Detection of Acinetobacter baumannii and Klebsiella pneumonia in
Patients with Suspected Bloodstream Infections
Abstract
The relatively long turnaround time and low sensitivity of traditional
blood culture may delay the effective antibiotic therapy in patients
with bloodstream infection (BSI). To reduce the morbidity and mortality
of BSI, a rapid and sensitive pathogen detection method is urgently
required. Acinetobacter baumannii and Klebsiella pneumonia are two major
microorganisms responsible for BSI. Here we reported a novel droplet
digital PCR (ddPCR) method that can detect A. baumannii and K. pneumonia
in whole blood samples within 4 h, with a specificity of 100% for each
strain and limit of detection at 0.93 copies/microliter for A. baumannii
and 0.27 copies/microliter for K. pneumonia. Clinical validation in 170
patients with suspected BSIs showed that, compared with blood culture
that reported 4 (2.4%) A. baumannii cases and 7 (4.1%) K. pneumonia
cases, ddPCR detected 23 (13.5%) A. baumannii cases, 26 (15.3%) K.
pneumonia cases, and 4 (2.4%) dual infection cases, including the 11
positive patients reported by blood culture. In addition, the positive
patients reported by ddPCR alone (n = 42) had significantly lower serum
concentrations of procalcitonin and lactate, SOFA and APACHE II scores,
and 28-day mortality than those reported by both blood culture and ddPCR
(n = 11), suggesting that patients with less severe manifestations can
potentially benefit from the guidance of ddPCR results. In conclusion,
our study suggests that ddPCR represents a sensitive and rapid method to
identify causal pathogens in blood samples and to guide the treatment
decisions in the early stage of BSI.