OBJECTIVE: Early identification of causative microorganism(s) in @entity1 with severe @entity281 is crucial to optimize antimicrobial use and @entity1 survival. However, current culture-based pathogen identification is slow and unreliable such that broad-spectrum antibiotics are often used to insure coverage of all potential organisms, carrying risks of overtreatment, @entity137 , and selection of multidrug-resistant bacteria. We compared the results obtained using a novel, culture-independent polymerase chain reaction/electrospray ionization-mass spectrometry technology with those obtained by standard microbiological testing and evaluated the potential clinical implications of this technique. DESIGN: Observational study. SETTING: Nine ICUs in six European countries. @entity1 : @entity1 admitted between October 2013 and June 2014 with suspected or proven @entity281 , @entity55 , or sterile fluid and tissue @entity281 were considered for inclusion. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We tested 616 @entity281 , 185 @entity55 , and 110 sterile fluid and tissue specimens from 529 @entity1 . From the 616 @entity281 samples, polymerase chain reaction/electrospray ionization-mass spectrometry identified a pathogen in 228 cases (37%) and culture in just 68 (11%). Culture was positive and polymerase chain reaction/electrospray ionization-mass spectrometry negative in 13 cases, and both were negative in 384 cases, giving polymerase chain reaction/electrospray ionization-mass spectrometry a sensitivity of 81%, specificity of 69%, and negative predictive value of 97% at 6 hours from sample acquisition. The distribution of organisms was similar with both techniques. Similar observations were made for @entity55 and sterile fluid and tissue specimens. Independent clinical analysis of results suggested that polymerase chain reaction/electrospray ionization-mass spectrometry technology could potentially have resulted in altered treatment in up to 57% of @entity1 . CONCLUSIONS: Polymerase chain reaction/electrospray ionization-mass spectrometry provides rapid pathogen identification in critically ill @entity1 . The ability to rule out @entity281 within 6 hours has potential clinical and economic benefits.

Rapid Diagnosis of Infection in the Critically Ill, a Multicenter Study of Molecular Detection in Bloodstream Infections, XXXX , and @entity281 .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'patient', 'PATIENTS'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infection', 'bloodstream infection'] @entity137 :: ('MESH:D064420', 'Disease') :: ['toxicity'] @entity55 :: ('MESH:D011014', 'Disease') :: ['pneumonia']
@entity55 :: (MESH:D011014,Disease) :: ['Pneumonia']
