Multiplex qPCR for the early detection of sepsis pathogens and its impact on antimicrobial therapy in critically ill patients.

Background and Objectives: Sepsis is a life threatening condition caused by a dysregulated host response to infection and is associated with high morbidity and mortality worldwide. Early bacterial detection and therapy with antibiotics improve outcomes. We compared multiplex quantitative PCR (qPCR) to traditional blood culture for early pathogen detection in critically ill patients with suspected sepsis. Materials and Methods: This prospective observational study included 200 critically ill ICU patients with suspected sepsis. Multiplex qPCR using the TRUPCR® Sepsis Panel was compared with conventional blood culture for pathogen detection. To assess sensitivity, specificity, PPV, and NPV, blood culture was used as the reference standard. Mortality, ICU stay, and antibiotic therapy time were studied. Multivariable logistic regression was adjusted for baseline severity (SOFA, APACHE II), septic shock, and antibiotic exposure. Results: Multiplex qPCR significantly reduced the time to initiation of appropriate antibiotic therapy (5.2 vs 8.3 hours, p<0.001). The assay demonstrated higher sensitivity compared with blood culture for pathogen detection. qPCR positivity was associated with shorter ICU stay and lower mortality; however, these associations were interpreted after adjustment for baseline illness severity. Conclusion: Multiplex qPCR can detect infections early and optimize antimicrobials for sepsis. These findings should be cautiously evaluated and corroborated in larger multicentre trials due to reduced specificity and observational nature.