病原微生物分子检测技术在脓毒症诊断与预后评估中的临床价值

脓毒症是宿主对感染反应失调从而引起的危及生命的器官功能障碍^[1-2],是引起住院患者死亡及远期预后不良的一大重要原因。全球每年脓毒症发病率为189/10万人,病死率为26.7%,而在需要转入重症监护室治疗的脓毒症患者病死率高达41.9%^ [1]。脓毒症病情变化迅速,早期诊断及尽早干预有助于改善患者预后^ [2]。病原菌检测可以为脓毒症的诊断及抗感染方案的制定提供依据,而目前传统培养学方法检出率低,且较为耗时,可能错过早期抗感染治疗的最佳时机。

Molecular-based detection technologies of pathogens for sepsis

Sepsis is one of the main causes of intensive care unit admission and the poor prognosis in critically ill patients. As sepsis progresses rapidly, antimicrobial therapy should be started as soon as possible. The present identification of pathogens, which is important for sepsis diagnosis and guiding antimicrobial therapy, is time-consuming and limited by poor detection performance, leading to the missing prompt and adequate antimicrobial therapy. Therefore, it is important to accelerate the identification of the causative species in patients with sepsis. Nowadays, many molecular-based detection techniques, characterized by fast detection and high sensitivity, have been applied in clinical practice, multiplex PCR and metagenomic sequencing, for example. In addition, some new molecular techniques, such as digital PCR, third generation sequencing and cell-free DNA sequencing are also being explored to make up for deficiencies of the current techniques, further accelerating the identification of pathogens, as well as improving the detection rate, which may provide new evidences for the early diagnosis, early identification of pathogens and prognostic assessment for patients with sepsis.