Rapid Bacterial Diagnostics and Their Effect on Patient Treatment and Outcome

The aim of this thesis is to validate new rapid diagnostic tests and to investigate if improving microbiological diagnostics influences patient outcome and management. Therefore a short introduction in the underlying clinical syndrome is warranted. Sepsis is a major complication of infection with a high morbidity and mortality. Table 1 shows the diagnostic criteria of sepsis and severe sepsis (20). In their review Angus and Wax (3) cited several studies that reported mortality rates varying from 20 to 52%. From a point prevalence survey of Van Gestel et al. (66) it was calculated that the annual number of admissions for severe sepsis in Dutch ICUs was 8643 ± 929 cases/year, which represents 0.054% of the Dutch population, 0.61% of hospital admissions and 11% of ICU admissions. In 2008 Surviving Sepsis Campaign published international guidelines for management of severe sepsis and septic shock (20). They used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system for assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations. Their key recommendations, relevant for microbiologists and clinicians alike were among others: obtain blood cultures before starting antibiotic therapy (1C); administer broad-spectrum antibiotic therapy within 1 h of diagnosis of severe sepsis with or without septic shock (1B,1D) ; reassess antibiotic therapy with microbiology and clinical data to narrow coverage, when appropriate (1C).

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