The Diagnostic Value of Fungal Surveillance Cultures in Critically Ill Patients

Abstract Background: Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is anticipated to act as a reservoir for infecting microorganisms, contributing to the development and relapses of ventilator-associated pneumonia (VAP). Once a biofilm has formed on an ETT surface it is difficult to eradicate. The aims of this clinical study were to compare biofilm formation on three widely used ETT´s with different surface properties and to explore possible predictive factors of biofilm formation. Methods: The grade of biofilm formation on endotracheal tubes of polyvinyl chloride (PVC), silicone-coated PVC, and PVC coated by noble metals were compared after mechanical ventilation for > 24 hours in critically ill patients. The comparison was based on scanning electron microscopy (SEM) observations of ETT surfaces and biofilm grading, surveillance and biofilm cultures, and the occurrence of VAP. Results: A high-grade (score ≥ 7) biofilm formation on the ETTs was associated with the development of VAP (OR, 4.17; 95% CI 1.14 to 15.3; p = 0.031). Silicone-coated ETTs and PVC tubes coated with noble metals were independently associated with reduced high-grade biofilm formation compared to non-coated PVC ETTs (OR, 0.18; 95% CI 0.06 to 0.59; p = 0.005 and OR, 0.34; 95% CI 0.13 to 0.93; p = 0.036, respectively). No significant difference was detected between silicon-coated ETTs and noble metal-coated ETTs (OR, 0.54; 95% CI 0.17 to 1.65; p = 0.278). The microbes found in the ETT biofilm were frequently found in surveillance cultures at intubation and often remained in the biofilm after appropriate antibiotic therapy. Colonization with common VAP pathogens in surveillance cultures or duration of invasive ventilation did not predict higher biofilm formation on ETTs. Conclusion: Biofilm formation on ETTs were an early and frequent event in critically ill patients. High-grade biofilm formation on ETTs was associated with the development of VAP. Silicone-coated ETTs and PVC tubes coated with noble metals were independently associated with reduced high-grade biofilm formation in comparison to non-coated PVC ETTs. Clinicians may consider changing the ETT after an episode of VAP to avoid microbial persistence and possibly VAP relapse.

Download Full-text

Prognostic and diagnostic value of eosinopenia, C-reactive protein, procalcitonin, and circulating cell-free DNA in critically ill patients admitted with suspicion of sepsis

Critical Care ◽

10.1186/cc13908 ◽

2014 ◽

Vol 18 (3) ◽

pp. R116 ◽

Cited By ~ 71

Author(s):

Jose Garnacho-Montero ◽

María J Huici-Moreno ◽

Antonio Gutiérrez-Pizarraya ◽

Isabel López ◽

Juan Márquez-Vácaro ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Diagnostic Value ◽

C Reactive Protein ◽

Cell Free Dna ◽

Reactive Protein ◽

Free Dna ◽

Circulating Cell Free Dna

Download Full-text

DIAGNOSTIC UTILITY OF PRESEPSIN AND PROCALCITONIN IN CRITICALLY ILL PATIENTS WITH SUSPECTED SEPSIS: COMPARISON WITH RECENT CLINICAL CRITERIA OF SEPSIS-3

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i6.309 ◽

2019 ◽

Vol 3 (6) ◽

Author(s):

Babak Alikiaie ◽

Sarah Mousavi ◽

Mohammad Nasri

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Diagnostic Value ◽

Suspected Sepsis ◽

Clinical Sepsis ◽

Clinical Criteria ◽

Decision Tools ◽

Sepsis Diagnosis ◽

Previous Definition ◽

Definition Of

Background: In this study, we aimed to investigate the diagnostic and prognostic utilities of presepsin and procalcitonin (PCT) in critically ill patients with suspected sepsis, for whom sepsis was diagnosed clinically based on the Survival Sepsis Campaign (SSC) criteria and to compare it with recent criteria of Sepsis-3. Methods: Blood samples for biomarker measurements of presepsin and PCT were drawn on days 1, 3 and 7 of ICU admission in a total of 26 patients. All patients were followed-up until death or discharge. All studied biomarkers were analyzed according to the diagnosis and severity of sepsis and for prognosis (all-cause mortality) at days 1, 3 and 7. Agreement between the diagnosis of clinical sepsis and presepsin or PCT-based sepsis was assessed using Cohen’s kappa Results: Clinical sepsis (based on Sepsis-3) and presepsin or PCT-based sepsis showed poor agreement (Kappa<0.4). Presepsin levels at day1 correlated significantly with mortality (r=0.45, P; 0.02). The diagnostic value of both presepsin and PCT to diagnose sepsis was weak (Area under curve (AUC) <0.75). The overall agreement in sepsis diagnosis was fair to good based on the both clinical criteria (P<0.05, Kappa: 0.5-0.75). More than 80% of patients (N=21) had sepsis based on presepsin upon admission. Both clinical criteria predicated that less than 20% of patients (N=5) had sepsis upon admission. Conclusion: Based on our findings, the overall agreement between the diagnosis of clinical sepsis and presepsin or PCT-based sepsis was poor. Also, our results show that the new Sepsis-3 definitions were accurate and equal to the previous definition of SSC guideline. Although, availability of diagnostic assays is variable in Iran, but, it seems that addition of developing decision tools that utilize biomarkers to help aid the rapid diagnosis of sepsis is necessary and may improve patient outcomes. Keywords: Presepsin, Pro Calcitonin, Sepsis, Diagnosis

Download Full-text

Serial surveillance cultures of skin and catheter hub specimens from critically ill patients with central venous catheters: molecular epidemiology of infection and implications for clinical management and research.

Journal of Clinical Microbiology ◽

10.1128/jcm.35.7.1784-1790.1997 ◽

1997 ◽

Vol 35 (7) ◽

pp. 1784-1790 ◽

Cited By ~ 42

Author(s):

I Atela ◽

P Coll ◽

J Rello ◽

E Quintana ◽

J Barrio ◽

...

Keyword(s):

Molecular Epidemiology ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Management ◽

Central Venous Catheters ◽

Central Venous ◽

Surveillance Cultures

Download Full-text

Bowel Ischemia in ICU Patients: Diagnostic Value of I-FABP Depends on the Interval to the Triggering Event

Gastroenterology Research and Practice ◽

10.1155/2017/2795176 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Stefan Ludewig ◽

Rami Jarbouh ◽

Michael Ardelt ◽

Henning Mothes ◽

Falk Rauchfuß ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Diagnostic Value ◽

Bowel Ischemia ◽

Icu Patients ◽

Fatty Acid Binding ◽

Sensitivity Specificity ◽

Serum And Urine

Background. Intestinal fatty acid-binding protein (I-FABP) has been shown to be of high diagnostic value in patients with acute mesenteric ischemia. Whether these results can be reproduced in critically ill patients on the ICU was to be investigated. Materials and Methods. I-FABP was measured in serum and urine of 43 critically ill patients in ICU when mesenteric ischemia was suspected. Bowel ischemia was confirmed in 21 patients (group 1). 22 patients who survived at least seven days without confirmation of ischemia were assigned to group 2. I-FABP levels were compared between the groups, and interval from the event that has triggered ischemia to I-FABP measurement was recorded. Results. For the identification of patients with mesenteric ischemia, sensitivity, specificity, and area under the curve (AUC) for serum and urine I-FABP were 33.3%, 95.5%, and 0.565 and 81.3%, 70.0%, and 0.694, respectively. I-FABP measurements performed within 12 to 48 h after the event that triggered ischemia showed a sensitivity, specificity, and AUC for serum and urine of 75%, 100%, and 0.853 and 100%, 73.3%, and 0.856, respectively. Conclusions. In ICU patients, one single I-FABP measurement at the time of clinical suspicion failed to reliably detect or exclude mesenteric ischemia. A higher diagnostic value of I-FABP was only confirmed in the early stages of mesenteric ischemia. I-FABP may be used most appropriately in perioperative monitoring.

Download Full-text

Head CT is of limited diagnostic value in critically ill patients who remain unresponsive after discontinuation of sedation

BMC Anesthesiology ◽

10.1186/1471-2253-9-3 ◽

2009 ◽

Vol 9 (1) ◽

Cited By ~ 4

Author(s):

Jay S Balachandran ◽

Mairaj Jaleel ◽

Manu Jain ◽

Niraj Mahajan ◽

Ravi Kalhan ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Diagnostic Value ◽

Head Ct

Download Full-text

Midregional Proadrenomedullin (MRproADM) Serum Levels in Critically Ill Patients Are Associated with Short-Term and Overall Mortality during a Two-Year Follow-Up

Mediators of Inflammation ◽

10.1155/2020/7184803 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Lukas Buendgens ◽

Eray Yagmur ◽

Axel Ginsberg ◽

Ralf Weiskirchen ◽

Theresa Wirtz ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Prognostic Biomarker ◽

Serum Levels ◽

Diagnostic Value ◽

Healthy Controls ◽

Icu Mortality ◽

Term Survival ◽

Overall Mortality

Adrenomedullin (ADM) is a peptide with pleiotropic effects in systemic inflammation. Its more stable precursor protein midregional proadrenomedullin (MRproADM) can be measured more reliably compared to ADM. Our objective was to investigate the potential role of MRproADM as a diagnostic and prognostic biomarker in critically ill patients at the intensive care unit (ICU). We therefore measured MRproADM in 203 ICU patients and 66 healthy controls. We found that MRproADM levels are significantly increased in critically ill patients as compared to healthy controls. MRproADM levels are significantly increased in patients with sepsis, but its diagnostic value for identifying sepsis is numerically lower than that of established markers (e.g., interleukin-6, C-reactive protein, and procalcitonin). MRproADM levels are closely correlated to endothelial and organ dysfunction, inflammation, and established clinical scores (APACHE II, SOFA, and SAPS2). MRproADM concentrations correlate with vasopressor use but not fluid balance. Increased MRproADM levels (cut−off>1.4 nmol/L) in critically ill patients are independent predictors of ICU and overall mortality during a follow-up of up to 26 months (OR 3.15 for ICU mortality, 95% CI 1.08-9.20, p=0.036; OR for overall mortality 2.4, 95% CI 1.12-5.34, p=0.026). Our study demonstrates the potential of MRproADM serum levels as a prognostic biomarker in critical illness for ICU mortality and long-term survival during follow-up.

Download Full-text

Pentraxin 3 as a Prognostic Biomarker in Patients with Systemic Inflammation or Infection

Mediators of Inflammation ◽

10.1155/2014/421429 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9 ◽

Cited By ~ 31

Author(s):

Siguan Liu ◽

Xin Qu ◽

Feng Liu ◽

Chunting Wang

Keyword(s):

Critically Ill ◽

Biological Markers ◽

Critically Ill Patients ◽

Prognostic Value ◽

Underlying Disease ◽

Diagnostic Value ◽

Classification Systems ◽

Disease Classification ◽

Pentraxin 3 ◽

Severity Of Disease

Purpose. The long pentraxin 3 (PTX3) is a key component of the humoral arm of the innate immune system. PTX3 is produced locally in response to proinflammatory stimuli. We reviewed the usefulness of systemic levels of PTX3 in critically ill patients with systemic inflammatory response syndrome (SIRS), sepsis, and bacteremia, focusing on its diagnostic and prognostic value.Methods. A PubMed search on PTX3 was conducted. The list of papers was narrowed to original studies of critically ill patients. Eleven papers on original studies of critically ill patients that report on PTX3 in SIRS, sepsis, or bacteremia were identified.Results. Systematic levels of PTX3 have little diagnostic value in critically ill patients with SIRS, sepsis, or bacteremia. Systemic levels of PTX3, however, have superior prognostic power over other commonly used biological markers in these patients. Systemic levels of PTX3 correlate positively with markers of organ dysfunction and severity-of-disease classification system scores. Finally, systemic levels of PTX3 remain elevated in the acute phase and decreased on recovery. Notably, the age of the patients and underlying disease affect systemic levels of PTX3.Conclusions. The diagnostic value of PTX3 is low in patients with sepsis. Systemic levels of PTX3 have prognostic value and may add to prognostication of patients with SIRS or sepsis, complementing severity-of-disease classification systems and other biological markers.

Download Full-text

Candida in the Respiratory Tract Potentially Triggers Galactomannan Positivity in Nonhematological Patients

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00138-19 ◽

2019 ◽

Vol 63 (6) ◽

Cited By ~ 2

Author(s):

M. Aigner ◽

M. Wanner ◽

P. Kreidl ◽

C. Lass-Flörl ◽

M. Lackner

Keyword(s):

Respiratory Tract ◽

Invasive Aspergillosis ◽

Critically Ill ◽

Critically Ill Patients ◽

False Positive ◽

Candida Glabrata ◽

Species Abundance ◽

Diagnostic Value ◽

Content Type ◽

Culture Positive

ABSTRACT BAL fluid samples from critically ill patients shared a rate of 29% false-positive galactomannan results. We aimed to determine whether Candida species abundance in BAL fluid causes galactomannan (GM) positivity. A total of 89 Candida culture-positive BAL fluid samples from patients without suspicion of invasive aspergillosis (IA) were analyzed. GM results were correlated with Candida species abundance, Candida species quantity, and patient data. Candida species quantities of ≥104/ml and Candida glabrata abundance were significantly associated with positive GM results. The added diagnostic value of GM in BAL fluid for diagnosing IA in critically ill patients is limited.

Download Full-text