scholarly journals Serial Procalcitonin Levels and Bacterial Etiology in Hospitalized Patients with Community-Acquired Pneumonia

2021 ◽  
Author(s):  
Pierre Ankomah ◽  
Suzanne M McCluskey ◽  
Michael Abers ◽  
Benjamin Bearnot ◽  
Phillip Schuetz ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Statistical Significance ◽  
Care Center ◽  
Accurate Determination ◽  
Tertiary Care ◽  
Community Acquired Pneumonia ◽  
Clinical Syndrome ◽  
Hospitalized Patients ◽  
Prognostic Utility ◽  
Microbial Etiology

Abstract Background: Accurate determination of the microbial etiology of pneumonia has important consequences for appropriate administration of antimicrobials and antimicrobial stewardship. Procalcitonin (PCT) is a biomarker that is finding increasing diagnostic and prognostic utility in lower respiratory infections, however, it remains unclear whether it can be helpful in predicting the bacterial etiology of pneumonia. In this study, we examined the relationship between serial PCT measurements and bacterial etiology in hospitalized patients with community-acquired pneumonia, including those at high risk for infections due to multi-drug resistant organisms (MDRO), to determine whether PCT at admission and its trajectory early in the hospital course of patients provides distinguishing information between different bacterial causes of pneumonia.Methods: We analyzed data collected from a prospective cohort study of 505 patients admitted to a tertiary care center with a clinical syndrome consistent with pneumonia. Bacterial etiology of pneumonia was determined from high quality respiratory samples, blood cultures and other relevant diagnostic tests according to standard protocols in conjunction with clinical review. Daily plasma procalcitonin levels were measured for these patients serially during the first four days of hospitalization. We compared procalcitonin levels associated with different bacterial etiologies of pneumonia over the first four days of admission, using the Mann-Whitney-U test to assess for statistical significance.Results: Out of 505 patients, the diagnosis of pneumonia was adjudicated in 322, and bacterial etiology determined in 64 cases. The predominant pathogens were Staphylococcus aureus (n = 19; 12 Methicillin Resistant (MRSA) and 7 Methicillin Susceptible (MSSA)), Pseudomonas aeruginosa (n = 12), Streptococcus pneumoniae (n = 6), and Haemophilus influenza (n=5). We found higher procalcitonin values for S. pneumoniae relative to other etiologies, a delayed rise for Pseudomonas over time, and consistently low PCT values for infections due to multiple bacteria. In addition, our results also suggest that procalcitonin values on the second day of hospitalization, rather than at admission, may have the most utility in distinguishing between bacterial etiologies.Conclusion: Serial procalcitonin values during the early course of bacterial pneumonia reveal a difference between pneumococcal and other bacterial etiologies, and may have an adjunct role in guiding antibiotic choice and duration.

scholarly journals Serial Procalcitonin Levels Correlate with Microbial Etiology in Hospitalized Patients with Pneumonia

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S351-S351 ◽  
Author(s):  
Pierre Ankomah ◽  
Suzanne Mccluskey ◽  
Michael Abers ◽  
Benjamin Bearnot ◽  
Shreya Patel ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Statistical Significance ◽  
Care Center ◽  
Tertiary Care ◽  
Pneumococcal Infections ◽  
Significant Difference ◽  
Prognostic Utility ◽  
Microbial Etiology ◽  
Hospital Days ◽  
The Relationship

Abstract Background Procalcitonin (PCT) is a biomarker that is finding increasing diagnostic and prognostic utility in lower respiratory infections. It remains unclear, however, whether it can be helpful in predicting the bacterial etiology of pneumonia, with a view to informing antibiotic choice and duration. This study examines the relationship between serial PCT measurements and microbial etiology in patients hospitalized for pneumonia to determine whether changes in PCT levels provide discriminatory information on microbial etiology. Methods We performed a subgroup analysis of data from a prospective cohort study of 505 patients admitted to a tertiary care center with findings concerning for pneumonia. Microbial etiology of pneumonia was determined from high quality respiratory samples, blood cultures or other relevant diagnostic tests according to standard protocols. Procalcitonin levels were measured serially during the first four days of hospitalization. We compared procalcitonin levels between different bacterial etiologies over the first four days of admission, using the Mann–Whitney-U test to assess for statistical significance. Results Out of 505 patients, the diagnosis of pneumonia was adjudicated in 317, and bacterial etiology determined in 62 cases. The predominant pathogens were Staphylococcus aureus (N = 18), Streptococcus pneumoniae (N = 6), Pseudomonas aeruginosa (N = 11) and Haemophilus influenza (N = 5). Admission levels of PCT were lowest in Pseudomonas infections and highest in pneumococcal infections, though not reaching statistical significance. On hospital days two and three, pneumococcal procalcitonin levels were significantly higher than all other etiologies, but on day four, there was no statistically significant difference in PCT values for different microbial etiologies. Conclusion Serial procalcitonin levels during the early course of bacterial pneumonia reveal a difference between pneumococcal and other bacterial etiologies, and may have an adjunct role in guiding antibiotic choice and duration. Disclosures All authors: No reported disclosures.

scholarly journals TO STUDY THE PREVALENCE AND CLINICAL PROFILE OF CHRONIC ATRIAL FIBRILLATION IN HOSPITALIZED PATIENTS

2014 ◽  
Vol 04 (02) ◽  
pp. 017-020
Author(s):  
Dharma Rao V. ◽  
Rajaneesh Reddy M. ◽  
Srikanth K. ◽  
Raj Kumar Prakash B. ◽  
Satya Prasad A. ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Care Center ◽  
Tertiary Care ◽  
Chronic Atrial Fibrillation ◽  
Hospitalized Patients ◽  
Clinical Profile ◽  
Female Dominance ◽  
Elderly Age ◽  
Female Ratio

Abstract: Objective: To determine the prevalence of chronic atrial fibrillation (AF) in a tertiary care center and to identify the clinical profile of chronic AF in hospitalized patients. Methods: All patients admitted to Mamata General Hospital in medicine/cardiology wards with chronic AF (persistent and permanent) during the period January 2012 to December 2012 were included into the study. The principal exclusion criteria were new onset AF and acute AF. Results: During the study period, 49 patients were admitted with chronic AF with an average of 45.44 years. A slight female dominance was seen with male: female ratio of 1:1.2. Half of the patients (51%) were below the age 50 years. The elderly age group comprised of only 16.3% of cases. The commonest presenting complaint was dyspnea followed by palpitation. Rheumatic valvular heart disease was seen more commonly in people below the age of 50 years whereas hypertension and ischemic heart disease after 50 years. Heart failure was the commonest condition associated with the chronic AF and was the cause of hospitalization in almost fifty percent of cases Conclusion: Chronic AF is still a cause of concern in India in people below the age of 50 years due to high prevalence of rheumatic fever inspite of advances in the medical field.

Preventing Adverse Drug Events in Hospitalized Patients

1994 ◽  
Vol 28 (4) ◽  
pp. 523-527 ◽  
Author(s):  
R. Scott Evans ◽  
Stanley L. Pestotnik ◽  
David C. Classen ◽  
Susan D. Horn ◽  
Sheron B. Bass ◽  
...  
Keyword(s):  
Adverse Drug Events ◽  
Salt Lake ◽  
Care Center ◽  
Tertiary Care ◽  
Salt Lake City ◽  
Hospitalized Patients ◽  
Drug Event ◽  
Antibiotic Administration ◽  
Type B ◽  
Lake City

OBJECTIVE: To use computerized adverse drug event (ADE) surveillance to help identify methods to reduce the number of ADEs in hospitalized patients. DESIGN: Prospective study of 79 719 hospitalized patients during a 44-month period. SETTING: LDS Hospital, a 520-bed tertiary care center affiliated with the University of Utah School of Medicine, Salt Lake City. INTERVENTION: Sequential study periods of at least one year each were compared. In the first period, data were collected but not reported to physicians, pharmacists, or nurses. In the subsequent study periods, three interventions (computerized alerts of drug allergies, standardized antibiotic administration rates, and timely physician notification of all ADEs) were made to reduce the number of type B (allergic or idiosyncratic reactions) and severe ADEs. RESULTS: In the first study period, we identified 56 type B ADEs during 120 213 patient days. During two subsequent study periods that included alerts to physicians of known drug allergies and standardized antibiotic administration rates, 8 type B events were identified during 113 237 patient days and 18 during 107 868 patient days, respectively (p<0.OO2). Early notification of physicians of all confirmed ADEs regardless of severity was associated with asignificant reduction of ADEs classified as severe from 41 during 113 859 patient days in the first study period to 12 during 103 071 patient days and 15 during 108 320 patient days in two subsequent study periods, respectively (p<0.00 1). CONCLUSIONS: Prospective surveillance of computer-based medical records for known drug allergies and appropriate drug administration rates can reduce the number of type B ADEs. Early ADE detection and notification of physicians permit drug and dosage changes that reduce the progression of mild and moderate ADEs to more severe conditions.

scholarly journals Diagnoses of hospitalized patients with skin abnormalities prompting biopsy by consulting dermatologists: A 3‐year review from a tertiary care center

2019 ◽  
Vol 47 (4) ◽  
pp. 346-356 ◽  
Author(s):  
Ariana Ellis ◽  
Steven D. Billings ◽  
Urmi Khanna ◽  
Christine B. Warren ◽  
Melissa Piliang ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Hospitalized Patients ◽  
Tertiary Care Center ◽  
Skin Abnormalities

scholarly journals Spectrum of cytological patterns in cervical PAP smears in a tertiary care center of Western region of Nepal

2019 ◽  
Vol 4 (1) ◽  
pp. 2-8
Author(s):  
Pragya Gautam Ghimire ◽  
Durga BC Rawat ◽  
Kavita Sinha ◽  
Kamar Jahan ◽  
Richa Shrestha
Keyword(s):  
Cervical Cancer ◽  
Epithelial Cell ◽  
Pap Smear ◽  
Statistical Significance ◽  
Care Center ◽  
Tertiary Care ◽  
Pap Smears ◽  
Low Grade ◽  
Squamous Intraepithelial Lesion ◽  
Intraepithelial Lesion

Introduction: Cervical cancer is a common health problem in Nepal. There is paucity of data regarding the spectrum of findings in cervical Pap in western Nepal. This study was aimed to study the cytological patterns in cervical Pap smears in patients in a tertiary hospital of Nepal. Methods: This is a prospective, cross sectional, hospital based study. Clinical features of patients who had presented with Pap smear was noted in a structured proforma. Pap smears were studied by a senior pathologist and reported based on revised Bethesda system (2014). Results: Most of the cases belonged to 31-40 years 399 (42.8%). Unsatisfactory/ inadequate sample was present in 133(14.05%) with obscuration due to inflammatory exudate being most common cause. Negative for intraepithelial lesion or malignancy rate was noted in 798 (85.54%) with 477(51.2%) being normal findings. Epithelial cell abnormalities were noted in 116 (14.5 %) smears. Low-grade squamous intraepithelial lesion constituted 321(34.5%), High grade squamous intraepithelial lesion 273(29.3 %) and Atypical squamous cells of undetermined significance 153(16.4%) of epithelial cell abnormalities. Squamous cell carcinoma was present in 9(1%) of all reviewed smears. There was no statistical significance between the age and abnormalities of Pap smear (p=0.9). Conclusions: Pap smear is pivotal in cervical cancer screening in developing countries. It also identifies various inflammatory, infective, benign and malignant pathologies at the earliest thereby decreasing the morbidity and mortality.

MicroRNA Expression Profiling of Cutaneous Squamous Cell Carcinomas Arising in Different Sites

2020 ◽  
Vol 163 (3) ◽  
pp. 538-545
Author(s):  
Alexander N. Rock ◽  
Mason D. Fisher ◽  
Gwenyth Amborski ◽  
Dawn C. Allain ◽  
Victoria Klee ◽  
...  
Keyword(s):  
Head And Neck ◽  
Squamous Cell ◽  
Mirna Expression ◽  
Statistical Significance ◽  
Care Center ◽  
Normal Skin ◽  
Tertiary Care ◽  
Tissue Samples ◽  
Qrt Pcr ◽  
Candidate Mirnas

Objective To examine the microRNA (miRNA) expression profile of cutaneous squamous cell carcinoma (cSCC) tumors from aggressive head and neck locations compared with nonaggressive anatomic sites and normal controls. Study Design Retrospective analysis of miRNA expression. Setting Tertiary care center. Subjects and Methods Tissue samples were collected from 3 anatomic regions: aggressive head and neck sites (ie, ears/lip), nonaggressive locations (ie, extremities/trunk), and adjacent normal skin. RNA was isolated from tissue cores of 45 samples (18 aggressive sites, 15 nonaggressive sites, and 12 normal-adjacent skin). miRNA expression analysis was completed for approximately 800 miRNAs using the NanoString nCounter panel. Five candidate miRNAs were selected for validation. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed on the original samples plus 30 additional tissue samples (7 aggressive sites, 14 nonaggressive sites, and 9 normal-adjacent skin). Results Five candidate miRNAs with significant differences in miRNA expression ( P < 0 ≤ .001) from discovery samples were selected: miR-21, miR-31, let-7g, miR-93, and miR-22. Relative expression for these miRNAs using qRT-PCR in the new sample set did not reveal any significant differences using 1-way analysis of variance. When sets were combined, miR-21 showed increased expression in aggressive tumors relative to nonaggressive tumors ( P = .009), but no others reached statistical significance. Conclusion cSCC behaves more aggressively when originating from specific anatomical subsites of the head and neck. Of 5 miRNAs evaluated, only miR-21 showed significantly higher expression in tumors from aggressive sites relative to nonaggressive sites. Larger sample sizes are needed to evaluate other miRNAs.

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