scholarly journals Presepsin as a Biomarker for Risk Stratification and Prognosis of Acute Cholangitis:A Single Center Prospective Cohort Study

2021 ◽  
Author(s):  
Hanyu Zhang ◽  
Zhaoqing Lu ◽  
Guoxing Wang ◽  
Di Wu ◽  
Xu Ge ◽  
...  
Keyword(s):  
Blood Culture ◽  
Risk Stratification ◽  
Bacterial Infection ◽  
Positive Blood Culture ◽  
Characteristic Curve ◽  
Acute Cholangitis ◽  
High Morbidity ◽  
Chi Square ◽  
Exact Test ◽  
Prognostic Assessment

Abstract Background: Presepsin is currently a promising biomarker for the early diagnosis and prognosis of acute bacterial infection. Acute cholangitis is caused by bacterial infection and has high morbidity and mortality. The study engaged to assess the grading and prognostic value of presepsin in patients with acute cholangitis. Methods: This study enrolled patients with acute cholangitis in the emergency department from May 1, 2019 to December 20, 2020. The patients were evaluated for severity by the 2018 Tokyo Guidelines for Acute Cholangitis. Patients’ baseline features and routine clinical data were collected. On admission, presepsin, procalcitonin (PCT) and systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores were determined; and blood cultures were performed. IBM SPSS software (version 22.0) was used. The comparation of values was performed by Pearson chi-square test or Fisher's exact test or Mann-Whitney U test. The area under the receiver operating characteristic curve (AUC), multivariate logistic regression, and correlation analysis were used to analyze this importance of determining the presepsin levels on admission for acute cholangitis. Results: In total, 330 patients, including 109, 101, and 120 patients classified as having mild, moderate, and severe cholangitis, respectively, were examined. The AUCs of presepsin were 0.713 in predicting severe acute cholangitis, better than those of white blood cell (WBC 0.411), C-reactive protein (CRP 0.615), PCT 0.608, and total bilirubin (T-Bil 0.441) (P<0.05). The AUC of presepsin in predicting 28-day mortality was higher than that of WBC, CRP, PCT, and T-Bil. The presepsin level in the positive blood culture group was higher than that in the negative blood culture group (P=0.000). The P values for correlations of presepsin with SIRS and SOFA scores were 0.002 and 0.000, respectively. Conclusions: Presepsin levels on admission were correlated with SIRS and SOFA scores. Presepsin may predict positive blood culture and 28-day mortality in patients with acute cholangitis, and it is superior to WBC, CRP, PCT, and T-Bil in the risk stratification and prognostic assessment of severe cholangitis. Trial registration: Ethical code of this study is 2018-P2-063-01 and acquired on May, 22, 2018.

scholarly journals Procalcitonin as a biomarker of bacterial infection in critically ill patients admitted with suspected Sepsis in Intensive Care Unit of a tertiary care hospital

2021 ◽  
Vol 37 (7) ◽  
Author(s):  
Afshan Bibi ◽  
Nida Basharat ◽  
Muhammad Aamir ◽  
Zujaja Hina Haroon
Keyword(s):  
Intensive Care ◽  
Blood Culture ◽  
Bacterial Infection ◽  
Critically Ill ◽  
Positive Blood Culture ◽  
Critically Ill Patients ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Significant Difference

Objective: To compare the diagnostic accuracy of procalcitonin (PCT), C- reactive protein (CRP), total leukocyte count (TLC) and lactate in critically ill patients admitted with suspicion of sepsis. Methods: It was a cross sectional study conducted at the department of Chemical Pathology and Endocrinology AFIP, Rawalpindi, in collaboration with Medical and surgical intensive care units (ICU) of CMH Rawalpindi from January 2019 to December 2019. A total of 126 patients of both genders with age above 18 years and fulfilling the inclusion criteria of systemic inflammatory response syndrome (SIRS) were inducted in the study. Results: Out of 126 patients 82 (65%) patients have positive blood culture results. Male predominance was noted in patients with positive blood culture. Out of 82 patients with positive blood culture results 69(84%) patients have positive PCT results as well whereas 13(15%) patients with positive blood culture results have negative PCT values. 57(69%) patients had Gram negative bacterial infection and 25(30%) patients had Gram positive bacterial infection. Significant difference was noted between the medians of PCT in blood culture positive and blood culture negative group (p value< 0.05) whereas no significant difference was found between medians of CRP, TLC and lactate between blood culture positive and blood culture negative patients (p value > 0.05). ROC curve analysis of PCT, CRP and TLC were done, keeping blood culture as reference standard, PCT showed largest area under the curve (AUC) and clearly outperformed TLC and CRP. PCT showed AUC of 0.781 as compared to CRP and TLC, which was 0.568 and 0.617 respectively. PCT showed sensitivity of 93.9%, specificity of 47.7%, positive predictive value (PPV) of 77% and negative predictive value (NPV) of 80.8%. Conclusion: Higher NPV makes it a reliable marker for screening out sepsis in suspected cases. doi: https://doi.org/10.12669/pjms.37.7.4183 How to cite this:Bibi A, Basharat N, Aamir M, Haroon ZH. Procalcitonin as a biomarker of bacterial infection in critically ill patients admitted with suspected Sepsis in Intensive Care Unit of a tertiary care hospital. Pak J Med Sci. 2021;37(7):---------.  doi: https://doi.org/10.12669/pjms.37.7.4183 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Environmental Drivers of Bacillus-Positive Blood Cultures in a Cancer Hospital, Sapporo, Japan

2018 ◽  
Vol 15 (10) ◽  
pp. 2201 ◽  
Author(s):  
Takahiro Fujita ◽  
Hiroshi Nishiura
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Characteristic Curve ◽  
Time Lag ◽  
Absolute Humidity ◽  
Blood Cultures ◽  
Japan Meteorological Agency ◽  
Environmental Drivers ◽  
Bacillus Species ◽  
Important Message

The Bacillus species is a well-documented causative pathogen of nosocomial bloodstream infection. The present study aimed to identify climatological variables that are associated with Bacillus-positive blood culture in Sapporo, Japan. All cases with Bacillus-positive blood cultures from January 2011 to December 2016 were retrospectively analysed. Climatological data from 2011 to 2016, including daily mean temperature and absolute humidity, were retrieved from the Japan Meteorological Agency. Employing a hazard-based statistical model to describe the non-homogeneous counting process in which temperature and absolute humidity act as explanatory variables, we computed all possible models with variable lengths of time lag. Akaike Information Criterion was computed to identify the best fitted model. High wavelet power at 12 months was identified for the period from 2013 onwards, which coincided with the time period in which sampling multiple sets of blood culture has been recommended. The temperature-only model with a lag of six days yielded a high sensitivity value (72.1%) and appeared to be the optimal model to predict Bacillus-positive blood culture with the highest area under the receiver operating characteristic curve value. Temperature was identified as a climatological driver of Bacillus-positive blood culture. Our statistical modelling exercise offers an important message for infection control practices to improve awareness among healthcare workers of the identified association and mechanically controlled in-room temperature.

Tu1560 Usefulness of a Proposed Scoring System and Biomarkers As Predictors of a Positive Blood Culture for Bacteremia in Acute Cholangitis

2016 ◽  
Vol 83 (5) ◽  
pp. AB608
Author(s):  
Takayoshi Nishino ◽  
Izumi Shirato ◽  
Maki Tobari ◽  
Tetsuya Hamano ◽  
Motoyasu Kan ◽  
...  
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Scoring System ◽  
Acute Cholangitis

scholarly journals 1039. Surveillance Blood Cultures Associated With Decreased Mortality in Gram-Negative Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S310-S311
Author(s):  
Stacey A Maskarinec ◽  
David Van Duin ◽  
Felicia Ruffin ◽  
Vance G Fowler Jr ◽  
Joshua T Thaden
Keyword(s):  
Blood Culture ◽  
Hospital Mortality ◽  
Positive Blood Culture ◽  
Blood Cultures ◽  
Statistical Testing ◽  
Chi Square ◽  
Gram Negative ◽  
Staphylococcus Aureus Bacteremia ◽  
Gram Negative Bacteremia ◽  
Persistent Bacteremia

Abstract Background Prior studies have suggested that surveillance blood cultures (SBCs) may not be indicated in the setting of Gram-negative bacteremia (GNB). However, it is unclear how particular microbial species influence the need for SBCs in GNB. Methods We conducted a prospective cohort study of inpatients at Duke with Staphylococcus aureus bacteremia (SAB) and GNB from 2002–2015. Patients who died &lt;24 hours from the first positive blood culture were excluded. Patients provided written informed consent. SBCs were defined as a blood culture drawn from 24 hours to 7 days from initial positive blood culture. Persistent bacteremia was defined as a positive SBC with the same organism. Statistical testing included Fishers exact and chi-square tests. Results There were 2856 episodes of bacteremia over the study period (SAB: 1,147 [40%]; GNB: 1,709 [60%]). SBCs were drawn in 87% (1,003/1,147) of SAB patients and 64% (1,097/1,709) of GNB patients. SBC rates varied by GNB species (P &lt; 0.001), being more commonly drawn for those patients with Pseudomonas bacteremia (128/159 [80%]) than those with Escherichia bacteremia (377/592 [62%]). In GNB, acquisition of SBCs, regardless of positivity, was associated with decreased in-hospital mortality (177/1,173 [15%] vs. 109/536 [20%]; P = 0.008). The in-hospital mortality benefit associated with SBCs varied with GNB species, including Pseudomonas (30/128 [23%] vs. 14/31 [45%]; P = 0.02) and Escherichia (33/377 [9%] vs. 37/215 [17%]; P = 0.003). In-hospital mortality in those with SAB was also lower when SBCs were drawn (143/1003 [14%] vs. 46/144 [32%]; P = 0.0001) (figure). In GNB, positive SBCs, relative to negative SBCs, was associated with increased in-hospital mortality (44/217 [20%] vs. 133/956 [14%]; P = 0.02). Persistent bacteremia occurred in 49% (494/1003) of SAB patients and 20% (217/1097) of GNB patients with SBCs. Persistent bacteremia risk differed by GNB species (P = 0.004), and was highest among those with Stenotrophomonas maltophilia (9/19 [47%]) or Serratia (24/76 [31%]). Conclusion Acquisition of SBCs in patients with GNB was associated with decreased mortality, and this was driven in part by species-specific differences. Disclosures D. Van Duin, achaogen: Scientific Advisor, Consulting fee. shionogi: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee. Astellas: Scientific Advisor, Consulting fee. Neumedicine: Scientific Advisor, Consulting fee. Roche: Scientific Advisor, Consulting fee. T2 Biosystems: Scientific Advisor, Consulting fee. V. G. Fowler Jr., Merck, Cerexa/Actavis, Pfizer, Advanced Liquid Logis, NIH, MedImmune, Basilea, Karius, Contrafect, Regneron, Genentech, Affinergy, Locus, Medical Surface, Inc., Achaogen, Astellas, Arsanis, Bayer, Cubist, Debiopharm, Durata, Grifols, Medicines Co, Novartis: Collaborator, Consultant and Scientific Advisor, Consulting fee, Research grant and Research support.

scholarly journals Uji Perbandingan Antibiotik Profilaksis Ceftriaxone versus Cefazolin pada Bedah Obstetri dan Ginekologi

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Asri Rahayu ◽  
Fita Rahmawati ◽  
Tri Murti Andayani ◽  
Ammar Siradjuddin
Keyword(s):  
Side Effects ◽  
Clinical Outcome ◽  
Controlled Trial ◽  
Prophylactic Antibiotic ◽  
Prophylactic Antibiotics ◽  
Surgical Patients ◽  
High Morbidity ◽  
Chi Square ◽  
Double Blind ◽  
Exact Test

Surgical site infection (SSI) is the most common complication in postoperative surgical patients which is associated with high morbidity, mortality, and cost burden. These complications can be prevented by giving proper prophylactic antibiotics. Cefazolin is a recommended prophylactic antibiotic, but in the practice in Indonesia hospital, there are still many uses of ceftriaxone. This study aimed to compare the clinical outcome and safety of cefazolin and ceftriaxone as prophylactic antibiotics in preventing SSI in obstetric and gynecological surgical patients. The study design was double-blind randomized controlled trial. The data collection was conducted from January to June 2020 at dr. Dradjat Prawiranegara Regional Hospital Serang. A total of 82 subjects who met the inclusion criteria were divided into two groups by block randomization, 41 subjects were given cefazolin and 41 subjects were given ceftriaxone. The clinical outcome was measured by preventing SSI for the effectiveness and side effects for safety outcomes in both groups. The comparison of effectiveness and side effects were analyzed using the bivariate test (chi-square or fisher’s exact test) and relative risk (RR). The study showed that the effectiveness of cefazolin was the same as ceftriaxone in preventing SSI for 30 days (RR= 0.89; p= 0.724; 95%CI: 0,193-3,133) with the number of SSI 12.2% vs 9.8%. Side effects included nausea, vomiting, and phlebitis was observed in the administration of antibiotic by intravenous push (IVP) pre-operating.  Cefazolin have safetier than ceftriaxone with the incidence of side effects were 9.8% vs 29.3% ((RR = 0,33; p= 0.003; 95% CI: 0.076-0.895).  Cefazolin is an antibiotic recommended by Indonesian Ministry of Health and the Association of Obstetrics and Gynecology.  This study encourages the use of cefazolin to prevent resistance due to ceftriaxone to overuse.

scholarly journals Management of Staphylococcus aureus Bloodstream Infections

2021 ◽  
Vol 7 ◽  
Author(s):  
Aurelia Kimmig ◽  
Stefan Hagel ◽  
Sebastian Weis ◽  
Christina Bahrs ◽  
Bettina Löffler ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Therapeutic Consequences ◽  
Open Questions

Staphylococcus aureus bloodstream infections are associated with a high morbidity and mortality. Nevertheless, significance of a positive blood culture with this pathogen is often underestimated or findings are misinterpreted as contamination, which can result in inadequate diagnostic and therapeutic consequences. We here review and discuss current diagnostic and therapeutic key elements and open questions for the management of Staphylococcus aureus bloodstream infections.

scholarly journals Analisis Penggunaan Antibiotik pada Pasien Sepsis Neonatus di RSUD Arifin Ahmad Provinsi Riau

2018 ◽  
Vol 11 (2) ◽  
pp. 12
Author(s):  
Nazardi Oyong ◽  
Inayah Inayah ◽  
Yuni Novita ◽  
Rizki Giofani
Keyword(s):  
Blood Culture ◽  
Life Expectancy ◽  
Bacterial Infection ◽  
Positive Blood Culture ◽  
Antibiotic Use ◽  
Sensitivity Test ◽  
Cross Sectional ◽  
Before And After ◽  
Study Population ◽  
Cross Sectional Design

Sepsis that is commonly caused by bacterial infection may cause death in neonates. The appropiate antibioticadministered will increase the life expectancy of neonates with sepsis. Objective of this study was to know the patternof antibiotic use and appropriateness of antibiotic use based on sensitivity test. The study used observational methodwith cross sectional design. The collected data were retrospective. The study population were neonates with sepsis inperinatal ward from Januari – December 2014. The criteria of inclusion were positive blood culture with sensitivity testsand use of antibiotics. The percentage of particular antibiotics used in neonates with sepsis before sensitivity testwere amikacin 64,3%; meropenem 62,9% and piperazine/tazobactam 50% with suitability of 27,1%. However, aftersensitivity test there were meropenem 38,6%, amikacin 30%, vancomycin 14,3% and piperaciline/tazobactam 14,3%with appropriateness of 64,3%. The most number of antibiotic used before and after sensitivity test were amikacin andmeropenem, respectively. There was a suitability enhancement between the use of antibiotics and sensitivity testresults.

scholarly journals Clinical study of enterocutaneous fistula

2017 ◽  
Vol 4 (9) ◽  
pp. 2972
Author(s):  
Mahadeo Namdeo Garale ◽  
Yogesh Prabhakar Takalkar ◽  
Karthik Venkatramani
Keyword(s):  
Enterocutaneous Fistula ◽  
Statistical Significance ◽  
Intestinal Fistula ◽  
Anatomical Location ◽  
High Morbidity ◽  
Chi Square ◽  
Exact Test ◽  
Colonic Fistula ◽  
Key Aspects ◽  
High Output

Background: An enterocutaneous fistulae (ECF) may be challenging to manage due to the large volume of fluid losses, that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death.Methods: This descriptive study was conducted prospectively in the Department of Surgery between September 2004 and August 2010. Patients whom develop ECF after surgery were included in the study while patients with esophageal, biliary, pancreatic, and perianal fistulas were excluded. The description of fistula included cause, anatomical location, fistula output, complications, and outcome. Fistula output was quantified by direct measurement, in the presence of drain or by calculating number of dressing pads soaked per day. To examine the statistical significance of association between attributes, Chi-square test and Fisher's exact test were used. A probability value of less than 5% (P < 0.05) was considered significant.Results: A total of 42 patients were included in the study, of which 23 were males and 19 were females and the male:female ratio was 1.2:1. Most patients with ECF were aged 41-50 (mean age, 44.23±2.72). Of the 42 patients, 9 patients had colonic fistula and the remaining had small intestinal fistula; 16 ileal, 5 duodenal, and 12 jejunal. There were 22 patients with high-output fistula as compared to 20 patients with low output fistula. Mortality was significantly higher in patients with males, age >60 years, high-output fistula, mesenteric ischemia as underlying pathology, serum albumin <2.5g/dl and re-surgery.Conclusions: Early diagnosis and stabilization form key aspects of management of ECF as most patients are managed conservatively. Prompt nutritional supplementation alters the outcome of this disease. High output fistulae required mostly surgical management and had high morbidity and mortality.

scholarly journals Simple indictor of increased blood culture contamination rate by detection of coagulase-negative staphylococci

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kei Yamamoto ◽  
Kazuhisa Mezaki ◽  
Norio Ohmagari
Keyword(s):  
Blood Culture ◽  
Positive Blood Culture ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Blood Cultures ◽  
Clinical Aspects ◽  
Contamination Rate ◽  
Coagulase Negative Staphylococci ◽  
Confidential Interval ◽  
Prediction Ability

AbstractCoagulase-negative staphylococci (CoNS) are the most frequent contaminating bacteria; therefore, we aimed to investigate an indicator of CoNS to predict the increase in blood culture contamination rate (ConR). We performed a retrospective study of selected patients, who underwent blood culture testing. Contamination was defined as the presence of either one of two or more sets of skin-resident bacteria, except for cases with a low likelihood of contamination based on clinical aspects. We calculated the monthly ConR [(total number of contaminated cases per month)/(total number of blood culture sets collected per month) × 100] and analysed the ConR prediction ability using the following four indicators: the number of CoNS-positive sets of blood cultures, cases with at least one CoNS-positive blood culture set, cases with only one CoNS-positive blood culture set, and cases of contamination by CoNS. Cases with CoNS-positive blood cultures correlated with ConR (r = 0.85). Although the area under the receiver operating characteristic curve for the number of cases with ConR ≥ 2.5 differed significantly from that of the number of cases contaminated by CoNS, the negative predictive value was high, reaching up to 95.5% (95% confidential interval 87.3–99.1). The number of CoNS-positive cases could help predict an increase in ConR ≥ 2.5.

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