Bacterial DNA detection in blood using PCR/ESI-MS in neonates with suspected early onset infection.

Objective: The study aimed to assess the relationship between clinical features, routine laboratory parameters, including conventional blood culture, and identification of microorganisms by a commercial system of Polymerase Chain Reaction coupled with Electrospray Ionization Mass Spectrometry (PCR/ESI-MS) (Abbot Iridica) in infants with suspected early-onset infection. Study design: Prospective observational cohort study. Setting: Neonatal intensive care unit and postnatal ward at a tertiary hospital within an urban setting. Patients: Neonates >=34 weeks gestation with clinically suspected early-onset infection between January 2016 and March 2017 were recruited. Blood samples were taken at the time of suspected infection for both blood culture inoculation (BacT/ALERT Results: 54 infants were studied with a median (IQR) gestational age and birth weight of 39.7 (37.5-41.0) weeks and 3.2 (2.7-3.5) kg respectively. 1 infant had both bacterial DNA detected on PCR/ESI-MS and bacterial growth on blood culture (Group B Conclusions: PCR/ESI-MS detected bacterial DNA of organisms considered pathogenic in four times more blood samples than culture alone, and had a high sensitivity and negative predictive value. Bacterial DNA was detected by PCR/ESI-MS in infants who did not have bacterial growth on blood culture and this was associated with a raised inflammatory marker. It may be a useful tool to exclude sepsis in the neonatal cohort and reassess the need for prolonged antibiotic treatment. The results are promising but there is a need to improve blood collection methods to take advantage of the potential benefits of molecular detection.