scholarly journals Associations Between Procalcitonin and Markers of Bacterial Sepsis

Medicina ◽  
2012 ◽  
Vol 48 (8) ◽  
pp. 57 ◽  
Author(s):  
Veeresh Patil ◽  
Jaymin Morjaria ◽  
Francois De Villers ◽  
Suresh Babu
Keyword(s):  
Bacterial Culture ◽  
White Cell Count ◽  
Bacterial Sepsis ◽  
Reactive Protein ◽  
Paired Samples ◽  
Positive Bacterial Culture ◽  
Specificity And Sensitivity ◽  
Significant Difference ◽  
Culture Positive ◽  
Culture Negative

Background. Bacterial sepsis with no bacterial isolates can be a difficult clinical conundrum, where other markers like C-reactive protein (CRP), white cell count (WCC), and neutrophilia are helpful to arrive at a diagnosis. Procalcitonin (PCT) has been shown to be a useful biomarker in bacterial sepsis. The aim of the study was to look at the association of PCT with bacterial cultures and compare this to currently used markers of bacterial sepsis. Material and Methods. WCC, neutrophil count, and CRP with PCT were compared in patients with a positive bacterial culture from blood/body fluid. The specificity and sensitivity of PCT were compared with those of CRP. Results. Of the 99 paired samples obtained, 25 cultures were positive for bacteria. There was a significant difference in CRP (P=0.04) and PCT (P<0.001) levels between culture-positive and culture-negative samples. PCT had a better sensitivity and specificity than CRP (84% and 64.9% vs. 69.6% and 52.9%, respectively), with a combined specificity (CRP and PCT) of 83.5%. Conclusions. PCT has a better association with bacterial sepsis and is superior to currently available biomarkers in the clinical setting. The rapid pharmacodynamics of PCT can serve as an early predictor of the diagnosis of bacterial sepsis while awaiting the bacterial culture results avoiding undue delay in the institution of antibiotics, hence, potentially improving the prognosis of patients with bacterial sepsis.

scholarly journals 657. Diagnostic Utility of Dedicated Fungal Blood Cultures for Diagnosis of Candidemia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S385-S385
Author(s):  
Bryant Yang ◽  
Omai Garner ◽  
Richard Ou ◽  
Nicholas Stanzione
Keyword(s):  
Antifungal Therapy ◽  
Bacterial Culture ◽  
De Novo ◽  
Empiric Therapy ◽  
Fungal Culture ◽  
Culture Techniques ◽  
Time To Positivity ◽  
Positive Bacterial Culture ◽  
Culture Positive ◽  
Culture Negative

Abstract Background Blood culture techniques have improved to the point where they are considered sensitive enough for detection of Candida. Expert guidelines clarifying the utility of use of dedicated fungal isolator cultures are lacking, and we wondered what utility, if any, they add for the diagnosis of candidemia. Methods All patients with cultures between March 2016-February 2020 positive for Candida were examined via manual chart review, noting time to positivity and time of initiation of antifungal therapy. Results We focused on cases of candidemia where a fungal culture was ordered and turned positive (59 out of the total 181 cases of candidemia). We eliminated an additional 10 cases where fungal cultures were sent while already on antifungal therapy or in patients already known to be fungemic, given our interest in de novo diagnoses. Another case was removed due to lack of clinical details, as the patient was discharged prior to culture results and managed at a different medical facility. There were 14 cases with discordant growth (fungal culture positive, bacterial culture negative). One patient passed away prior to culture results, but in the remaining 13 cases, the fungal culture changed clinical management, in most cases by prompting initiation of antifungal therapy. The remaining 36 cases involved with concordant growth between bacterial and fungal cultures. In 11 of those cases, the fungal culture isolated yeast 12 or more hours faster than its paired bacterial culture (average 40.7 +/- 26.6 hours). In 7 of these cases, the fungal culture changed management – in the remaining cases, the patient was already on empiric therapy. Among all cultures sent in patients not receiving antifungals that isolated Candida, the overall time to positivity for fungal cultures was 37.2 +/- 13 hours, while bacterial cultures took 54 +/- 26.4 hours. Fungal Culture Results Conclusion Fungal cultures changed management in 20/59 cases of candidemia (34%) either by making the diagnosis faster than a bacterial culture or making it outright. Given the morbidity and mortality associated with candidemia, rapid diagnosis is critically important. More specific guidelines optimizing how to best utilize fungal cultures to help standardize practice among clinicians will be critical going forward. Disclosures Omai Garner, PhD, D(ABMM), Beckman Coulter (Scientific Research Study Investigator)

Etiology of Pertussis Syndrome

PEDIATRICS ◽  
1980 ◽  
Vol 66 (1) ◽  
pp. 50-55
Author(s):  
Margaret A. Keller ◽  
Rouben Aftandelians ◽  
James D. Connor
Keyword(s):  
Bordetella Pertussis ◽  
Bacterial Culture ◽  
Index Case ◽  
Family Group ◽  
Isolation Rate ◽  
Bordetella Parapertussis ◽  
Positive Bacterial Culture ◽  
Serologic Evidence ◽  
Family Contact ◽  
Culture Negative

One hundred patients with clinical pertussis were studied to determine the etiology of pertussis syndrome. Forty-two (42%) of the patients had either Bordetella pertussis or Bordetella parapertussis isolated from the nasopharynx. In an additional 36 (36%) patients, B pertussis was isolated from the nasopharynx of the associated index case or family contact case. Thus, Bordetella was isolated from 78 (78%) of the patients or from their immediate family group. Of the 22 culture-negative patients residing in culture-negative families, 12 had serologic evidence of Bordetella infection and another was from a family group in which two members were seropositive. Therefore, 91 patients (91%) had bacteriologic or serologic evidence of Bordetella infection themselves or within their families. Viral cultures were obtained on 75 of the patients. Adenoviruses were isolated from 33% of those with positive cultures for B pertussis and from 14% of those with negative cultures. In the group without direct or indirect, bacteriologic or serologic evidence of Bordetella infection, the adenoviral isolation rate (13%) was not significantly different from the adenoviral isolation rate (33%) in patients with a positive bacterial culture. These data do not support a role for adenovirus alone in causing pertussis syndrome.

scholarly journals Procalcitonin and Interleukin-6 for predicting culturenegative and culture positive bacterial sepsis in critically ill patients with systemic inflammatory response syndrome

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Mohd Basri Mat Nor ◽  
Azrina Md Ralib
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Interleukin 6 ◽  
Systemic Inflammatory Response ◽  
Bacterial Sepsis ◽  
Saps Ii Score ◽  
Culture Positive ◽  
Culture Negative

Introduction: Differentiation between culture-negative bacterial sepsis (BS), culturepositive BS and non-infectious systemic inflammatory response syndrome (SIRS) among critically ill patients remains a diagnostic challenge to the intensive care unit (ICU) physicians. This study aimed to evaluate the role of procalcitonin (PCT) and interleukin-6 (IL-6) in predicting non-infectious SIRS, culture-negative BS and culture-positive BS in the ICU. Methods: This prospective observational study was conducted in a tertiary ICU in Pahang. The patients were divided into sepsis and non-infectious SIRS based on clinical assessment with or without positive cultures. Patients with positive cultures were further divided into bacteraemia and positive other culture. The PCT and IL-6 were measured daily over the first 3 days. Results: Two hundred and thirty nine consecutive patients diagnosed with SIRS were recruited, of whom 164 (69%) had sepsis. Among sepsis patients, there were 62 (37.8%) culture positive and 102 (62.2%) culture negative. Of these, 27 (16.5%) develop bacteraemia. The most common site of infection was respiratory (34.4%). Post-LSD analyses showed significant difference in the PCT between culture negative sepsis and SIRS (p=0.01); and positive other culture and SIRS (p=0.04).  On the other hand IL-6 cannot differentiate between SIRS and negative culture sepsis (p=0.06). Both PCT and IL-6 predicted bacteraemia with an AUC of 0.70 (0.57 to 0.82) and 0.68 (0.53 to 0.70). IL-6 is independently associated with bacteraemia and other culture after adjusting for age, sex, hypertension, SAPS II score and day 1 PCT. Conclusions: Procalcitonin but not Interleukin-6 is able to differentiate SIRS from culture-negative BS. However, IL-6 is independently associated with bacteraemia and other culture.

scholarly journals Procalcitonin as an Acute Phase Marker

2001 ◽  
Vol 38 (5) ◽  
pp. 483-493 ◽  
Author(s):  
John Whicher ◽  
Jacques Bienvenu ◽  
Guillaume Monneret
Keyword(s):  
Bacterial Infection ◽  
Acute Phase ◽  
Acute Phase Proteins ◽  
Gene Products ◽  
Bacterial Sepsis ◽  
C Reactive Protein ◽  
Blood Concentrations ◽  
Reactive Protein ◽  
Specificity And Sensitivity ◽  
Systemic Bacterial Infection

Procalcitonin is a 14-kDa protein encoded by the Calc-I gene along with calcitonin and katacalcin. The function and regulation of this protein are quite different from those of the other gene products. Blood concentrations of procalcitonin are increased in systemic inflammation, especially when this is caused by bacterial infection. Studies of its behaviour in patients with bacterial sepsis have led to the proposal that it may be a useful marker of systemic bacterial infection, with greater specificity and sensitivity than acute phase proteins such as C-reactive protein.

scholarly journals Comparing mortality between positive and negative blood culture results: an inverse probability of treatment weighting analysis of a multicenter cohort

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aibo Liu ◽  
Chia-Hung Yo ◽  
Lu Nie ◽  
Hua Yu ◽  
Kuihai Wu ◽  
...  
Keyword(s):  
Propensity Score ◽  
Blood Culture ◽  
Early Mortality ◽  
Negative Blood Culture ◽  
Late Mortality ◽  
Inverse Probability ◽  
Propensity Score Model ◽  
Significant Difference ◽  
Culture Positive ◽  
Culture Negative

Abstract Background The association between blood culture status and mortality among sepsis patients remains controversial hence we conducted a tri-center retrospective cohort study to compare the early and late mortality of culture-negative versus culture-positive sepsis using the inverse probability of treatment weighting (IPTW) method. Methods Adult patients with suspected sepsis who completed the blood culture and procalcitonin tests in the emergency department or hospital floor were eligible for inclusion. Early mortality was defined as 30-day mortality, and late mortality was defined as 30- to 90-day mortality. IPTW was calculated from propensity score and was employed to create two equal-sized hypothetical cohorts with similar covariates for outcome comparison. Results A total of 1405 patients met the inclusion criteria, of which 216 (15.4%) yielded positive culture results and 46 (21.3%) died before hospital discharge. The propensity score model showed that diabetes mellitus, urinary tract infection, and hepatobiliary infection were independently associated with positive blood culture results. There was no significant difference in early mortality between patients with positive or negative blood culture results. However, culture-positive patients had increased late mortality as compared with culture-negative patients in the full cohort (IPTW-OR, 1.95, 95%CI: 1.14–3.32) and in patients with severe sepsis or septic shock (IPTW-OR, 1.92, 95%CI: 1.10–3.33). After excluding Staphylococcal bacteremia patients, late mortality difference became nonsignificant (IPTW-OR, 1.78, 95%CI: 0.87–3.62). Conclusions Culture-positive sepsis patients had comparable early mortality but worse late mortality than culture-negative sepsis patients in this cohort. Persistent Staphylococcal bacteremia may have contributed to the increased late mortality.

scholarly journals Antimicrobial Susceptibility among Pathogens Isolated in Early- versus Late-Onset Ventilator-Associated Pneumonia

2021 ◽  
Vol 13 (2) ◽  
pp. 401-410
Author(s):  
Hend Ben Lakhal ◽  
Aymen M’Rad ◽  
Thierry Naas ◽  
Nozha Brahmi
Keyword(s):  
Early Onset ◽  
Bacterial Culture ◽  
Late Onset ◽  
Multidrug Resistant ◽  
First Episode ◽  
High Morbidity ◽  
Ventilator Associated Pneumonia ◽  
Bacterial Isolates ◽  
Positive Bacterial Culture ◽  
Significant Difference

Ventilator-associated pneumonia (VAP) is associated with increased hospital stay and high morbidity and mortality in critically ill patients. The aims of this study were to (i) determine the incidence of multidrug-resistant (MDR) pathogens in the first episodes of VAP and to assess potential differences in bacterial profiles of subjects with early- versus late-onset VAP. This was a retrospective cohort study over a period of 18 months including all patients who had a first episode of VAP confirmed by positive bacterial culture. Subjects were distributed into two groups according to the number of intubation days: early-onset VAP (<5 days) or late-onset VAP (≥5 days). The primary endpoint was the nature of causative pathogens and their resistance profiles. Sixty patients were included, 29 men and 31 women, with an average age of 38 ± 16 years. The IGS 2 at admission was 40.5 [32–44] and APACHE was 19 [15–22]. Monomicrobial infections were diagnosed in 77% of patients (n = 46). The most frequently isolated bacteria were A. baumannii, 53% (n = 32); P. aeruginosa in 37% (n = 22); Enterobacterales in 28% (n = 17) and S. aureus in 5% (n = 3). Ninety-seven percent of the bacteria were MDR. The VAP group comprised 36 (60%) episodes of early-onset VAP and 24 (40%) episodes of late-onset VAP. There was no significant difference in the distribution of the bacterial isolates, nor in terms of antibacterial resistances between early- and late-onset VAPs. Our data support recent observations that there is no microbiological difference in the prevalence of potential MDR pathogens or in their resistance profiles associated with early- versus late-onset VAPs, especially in countries with high rates of MDR bacteria.

scholarly journals 341 The Diagnosis and Management of Appendicitis During the COVID-19 Pandemic: The Pennine Acute Trust Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
D Idama ◽  
G Aldersley ◽  
M Connolly ◽  
A O'Connor
Keyword(s):  
White Cell Count ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Symptom Duration ◽  
C Reactive Protein ◽  
Diagnosis And Management ◽  
Reactive Protein ◽  
Significant Difference ◽  
Computed Topography ◽  
Acute Trust

Abstract Introduction Appendicitis management has evolved recently with more reliance on Computed Topography (CT) and laparoscopic surgery being commonplace. In this project we looked at how the Coronavirus pandemic (COVID-19) had impacted the diagnosis, management and outcomes of patients with appendicitis in our unit. Method A retrospective review of patients diagnosed with appendicitis from 1st March – 30th April in 2019 and 2020. Data was collected on diagnosis, management and outcomes. Results In 2020, 91 patients were identified (mean 33, range 6-85, F:M 1:1.4). In 2019, 107 patients were identified (mean 32, range 7-69, M:F 1:1.1). There was no significant difference in patients’ symptom duration (p = 0.21), White Cell Count (p = 0.20) or C-Reactive Protein (p = 0.10). More CTs were performed in 2020 (56/91, 61.5%) than in 2019 (40/107, 37.4%). Less patients underwent appendicectomy in 2020 (75/91, 82.4%) than in 2019 (104/107, 97.2%). Open appendicectomies were performed in 64% (48/75) of those operated in 2020 compared with 12.2% (13/104) in 2019. There was no difference in hospital length of stay or re-admissions rates. Conclusions The diagnosis and management of appendicitis changed considerably at our trust during COVID-19 with more reliance on CT diagnosis and less use of laparoscopy. Despite this, outcomes remained unchanged.

scholarly journals Study of Platelet Parameters with Different Isolated Organism in Neonatal Bacterial Sepsis

2021 ◽  
pp. 14-20
Author(s):  
Rajiv Kumar Prasad ◽  
Amita Uday Surana ◽  
Chetan Chovatiya ◽  
Radhika Iyer ◽  
Nidhi Modi
Keyword(s):  
Prospective Observational Study ◽  
Platelet Response ◽  
Bacterial Sepsis ◽  
Coagulase Negative Staphylococci ◽  
Gram Positive ◽  
Gram Negative ◽  
Significant Difference ◽  
Prolonged Duration ◽  
Severe Degree ◽  
Culture Positive

Background: Thrombocytopenia is a common hematological abnormality observed in neonatal sepsis and considered as early, nonspecific marker of sepsis. The studies related to organism specific platelet response are few. Objective: To assess the prevalence of thrombocytopenia and to study changes in various platelet parameters in relation to different isolated organism. Methods: A prospective observational study involving neonates with 1st episode of culture positive sepsis was done over a period of 18 months. The platelet parameters studied were incidence, degree, duration of thrombocytopenia; mean platelet volume and platelet nadir among neonate with specific organism isolated. Results: Out of 114 culture positive sepsis 31% Klebsiella, 30% Pseudomonas, 13% Citrobacter, 18% CONS, 4% Staphylococcus Aureus (S Aureus) and 3% had Acinetobacter sepsis. Overall prevalence of thrombocytopenia was 88%, of which klebsiella and S. Aureus sepsis observed 100% prevalence of thrombocytopenia followed by 88% pseudomonas, 80% coagulase negative staphylococci (CONS), 75% Acinetobacter and 66% Citrobacter sepsis. The proportion of severe degree of thrombocytopenia (18% Vs 4%), higher MPV (61% Vs 54%) and longer duration of thrombocytopenia (3.63 ± 0.49 Vs 2.95 ± 0.52) was observed more with Gram negative sepsis than with Gram positive sepsis and statistically significant difference in platelet nadir was observed with Gram negative sepsis. Severe degree of thrombocytopenia was seen in 50% neonates with Acinetobacter and 23% with Klebsiella sepsis. Acinetobacter, Klebsiella and Pseudomonas sepsis had higher mean MPV value, longer duration of thrombocytopenia and lowest platelet nadir.  The platelet parameters were less affected with Gram positive organism. Conclusion: Thrombocytopenia is a frequent occurrence in neonates with sepsis especially with Gram negative organism. Sepsis with Acinetobacter, Klebsiella & Pseudomonas organism was associated with prolonged duration, higher MPV and lower platelet count as compared to                    other isolated organisms.

scholarly journals Two-stage revision for the culture-negative infected total hip arthroplasty

2018 ◽  
Vol 100-B (1_Supple_A) ◽  
pp. 3-8 ◽  
Author(s):  
M. S. Ibrahim ◽  
H. Twaij ◽  
F. S. Haddad
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Similar Rate ◽  
Two Stage ◽  
Total Hip ◽  
Significant Difference ◽  
Complex Culture ◽  
Culture Positive ◽  
Culture Negative

Aims Periprosthetic joint infection (PJI) remains a challenging complication following total hip arthroplasty (THA). It is associated with high levels of morbidity, mortality and expense. Guidelines and protocols exist for the management of culture-positive patients. Managing culture-negative patients with a PJI poses a greater challenge to surgeons and the wider multidisciplinary team as clear guidance is lacking. Patients and Methods We aimed to compare the outcomes of treatment for 50 consecutive culture-negative and 50 consecutive culture-positive patients who underwent two-stage revision THA for chronic infection with a minimum follow-up of five years. Results There was no significant difference in the outcomes between the two groups of patients, with a similar rate of re-infection of 6%, five years post-operatively. Culture-negative PJIs were associated with older age, smoking, referral from elsewhere and pre-operative antibiotic treatment. The samples in the culture-negative patients were negative before the first stage (aspiration), during the first-stage (implant removal) and second-stage procedures (re-implantation). Conclusion Adherence to strict protocols for selecting and treating culture-negative patients with a PJI using the same two-stage revision approach that we employ for complex culture-positive PJIs is important in order to achieve control of the infection in this difficult group of patients. Cite this article: Bone Joint J 2018;(1 Supple A)100-B:3–8.

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