scholarly journals Biomarkers of infection in the optimization of antibacterial therapy: justified expectations

2020 ◽  
pp. 175-187
Author(s):  
Vladimir V. Kulabukhov ◽  
А.К. Shabanov ◽  
Irina V. Andreeva ◽  
Оlga U. Stetsiouk ◽  
V.А. Andreev
Keyword(s):  
Antibiotic Therapy ◽  
Continuous Improvement ◽  
Bacterial Infections ◽  
Response To Therapy ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Serious Bacterial Infections ◽  
Time Point

Despite the continuous improvement of approaches to antimicrobial therapy and the emergence of new highly effective antibiotics, severe bacterial infections being a significant cause of morbidity and mortality remain a top of mind issue for clinicians. Immediate initiation of the effective antibiotic therapy is an essential component of the successful treatment of serious bacterial infections, and therefore, special attention should be paid to the timely diagnosis. Measurements of biomarkers of inflammation (C-reactive protein, procalcitonin, presepsin, proadrenomedullin) in combination with clinical evaluation are important at first for the diagnosis of bacterial infection, and after that these can help to assess the clinical response to therapy and determine the time-point of antibiotics withdrawal. This review presents the characteristics of the main markers of inflammation, discusses the situations when determination of biomarkers is appropriate, and also provides modern clinical recommendations and algorithms regarding the use of these diagnostic markers in the management of patients with bacterial infections.

#54: Sensitivity and Specificity of Procalcitonin vs C Reactive Protein in Identifying Pediatric Bacterial infections

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S16-S16
Author(s):  
Sara Kim ◽  
Avni Bhatt ◽  
Silvana Carr ◽  
Frances Saccoccio ◽  
Judy Lew
Keyword(s):  
Urinary Tract ◽  
Sensitivity And Specificity ◽  
Urinary Tract Infections ◽  
Bacterial Infections ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Culture Positivity ◽  
Serious Bacterial Infections ◽  
Tract Infections ◽  
Culture Positive

Abstract Background Procalcitonin (PCT) and c-reactive protein (CRP) have been utilized in children to assess risk for serious bacterial infections. However, there have been different cut-offs reported for PCT and CRP, which yield different sensitivity and specificity. This study aims to compare the sensitivity and specificity of PCT and CRP in detecting serious bacterial infections (SBIs), specifically urinary tract infections, bacteremia and meningitis. Methods In this retrospective, single center cohort study from January 2018 to June 2019, we analyzed children with a fever greater than 38C with both PCT and CRP value within 24 hours of admission. Each patient had a blood, urine and/or cerebrospinal fluid culture collected within 48 hours of admission. No antibiotics were administered from the admitting hospital prior to collection of the PCT or CRP. Our gold standard was a positive culture obtained from blood, cerebrospinal fluid, or urine. The statistical analysis included categorical variables as percentages and compared them using the Fisher exact test. The optimal cutoff values for PCT or CRP were based on ROC curve analysis and Youden Index. Sensitivity and specificity analysis were based on literature review cut offs and ROC curves cut offs. Results Among 202 children, we had 45 culture positive patients (11 urinary tract infections, 4 meningitis, and 32 bacteremia). The patients with culture positivity had higher PCT levels (7.9 ng/mL vs 2.5 ng/mL, P=0.0111), CRP levels (110.9 mg/L vs 49.6 mg/L, P<0.0001) and temperature (39.2C vs 39C, P<0.0052). The area under the curve (AUC) comparing culture positivity vs negativity for all culture types was 0.72 (p<0.0001) for PCT and 0.66 (p=0.001) for CRP. In Figure 1, the AUC for culture positive bacteremia was 0.68 (p=0.0011) for PCT and 0.70 (p=0.0003). The AUC for culture positive urinary tract infections (UTI) only was 0.86 (p=0.0001) for PCT and 0.70 (p=0.3607). For the cut-off value for PCT at 0.5 ng/mL, the sensitivity and specificity was 64% (95% confidence interval [CI] 0.5–0.77) and 70% (95% CI 0.62–0.77) respectively in identifying children with bacterial infection. For the cut-off value for CRP at 20 mg/L, the sensitivity and specificity was 67% (95% CI 0.52–0.79) and 52% (95% CI 0.44–0.59) respectively in identifying children with bacterial infection. Conclusion In this study, PCT and CRP are nearly equivalent classifiers for detecting SBIs as a group and bacteremia, but PCT is statistically better for urinary tract infections; however, the clinical utility is unknown.

scholarly journals Diagnostic Accuracy of Procalcitonin, Neutrophil-to-Lymphocyte Ratio, and C-Reactive Protein in Detection of Bacterial Infections and Prediction of Outcome in Nonneutropenic Febrile Patients with Lung Malignancy

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Shanshan Ding ◽  
Jun Ma ◽  
Xingguo Song ◽  
Xiaohan Dong ◽  
Li Xie ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Bacterial Infections ◽  
White Blood Cells ◽  
Neutrophil To Lymphocyte Ratio ◽  
C Reactive Protein ◽  
Lymphocyte Ratio ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Retrospective Clinical Study ◽  
The Absolute

Background. Procalcitonin (PCT), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR) have emerged as important markers of inflammation, and these markers, especially PCT and CRP, have been studied in patients with neutropenia. This study was designed to evaluate their value in differentiating infectious fever from tumor fever (TF) and to investigate their role in assessing outcomes in nonneutropenic lung cancer patients (NNLCPs). Methods. This retrospective clinical study included 588 febrile NNLCPs between January 2019 and December 2019. The levels of PCT, CRP, and conventional inflammatory markers, including white blood cells (WBC) and neutrophils (NEU), were measured. NLR was defined as the ratio of the absolute neutrophil count to the absolute lymphocyte count. Patients’ clinical and bacteriological data were recorded. Results. This study included 311 NNLCPs with bacterial infections and 277 with TF. Inflammatory markers such as PCT, CRP, WBC, and NEU levels and NLR were significantly higher in patients with bacterial infections than in those with TF (p < 0.0001). However, PCT level was the best predictor of bacterial infections, with an area under the curve (AUC) of 0.874, followed by CRP level (AUC = 0.855) and NLR (AUC = 0.792) (p < 0.0001). Additionally, PCT level was significantly elevated in patients with bacterial infections with progressive disease after radiotherapy and chemotherapy (p < 0.01). Conclusions. The present study demonstrated the superiority of PCT over CRP and NLR in the diagnosis of febrile patients with bacterial infections. Additionally, PCT can be used to assess the clinical outcomes and cancer progression in NNLCPs.

C-reactive protein as a marker of serious bacterial infections in hospitalized febrile infants

2009 ◽  
Vol 98 (11) ◽  
pp. 1776-1780 ◽  
Author(s):  
Efraim Bilavsky ◽  
Havatzelet Yarden-Bilavsky ◽  
Shai Ashkenazi ◽  
Jacob Amir
Keyword(s):  
Bacterial Infections ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Serious Bacterial Infections

scholarly journals C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19

Infection ◽  
2021 ◽  
Author(s):  
Isabell Pink ◽  
David Raupach ◽  
Jan Fuge ◽  
Ralf-Peter Vonberg ◽  
Marius M. Hoeper ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Bacterial Infections ◽  
Roc Analysis ◽  
Secondary Infection ◽  
C Reactive Protein ◽  
Laboratory Findings ◽  
Secondary Bacterial Infection ◽  
Reactive Protein ◽  
Tract Infections

Abstract Purpose Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 (SARS-CoV-2) has spread around the world. Differentiation between pure viral COVID-19 pneumonia and secondary infection can be challenging. In patients with elevated C-reactive protein (CRP) on admission physicians often decide to prescribe antibiotic therapy. However, overuse of anti-infective therapy in the pandemic should be avoided to prevent increasing antimicrobial resistance. Procalcitonin (PCT) and CRP have proven useful in other lower respiratory tract infections and might help to differentiate between pure viral or secondary infection. Methods We performed a retrospective study of patients admitted with COVID-19 between 6th March and 30th October 2020. Patient background, clinical course, laboratory findings with focus on PCT and CRP levels and microbiology results were evaluated. Patients with and without secondary bacterial infection in relation to PCT and CRP were compared. Using receiver operating characteristic (ROC) analysis, the best discriminating cut-off value of PCT and CRP with the corresponding sensitivity and specificity was calculated. Results Out of 99 inpatients (52 ICU, 47 Non-ICU) with COVID-19, 32 (32%) presented with secondary bacterial infection during hospitalization. Patients with secondary bacterial infection had higher PCT (0.4 versus 0.1 ng/mL; p = 0.016) and CRP (131 versus 73 mg/L; p = 0.001) levels at admission and during the hospital stay (2.9 versus 0.1 ng/mL; p < 0.001 resp. 293 versus 94 mg/L; p < 0.001). The majority of patients on general ward had no secondary bacterial infection (93%). More than half of patients admitted to the ICU developed secondary bacterial infection (56%). ROC analysis of highest PCT resp. CRP and secondary infection yielded AUCs of 0.88 (p < 0.001) resp. 0.86 (p < 0.001) for the entire cohort. With a PCT cut-off value at 0.55 ng/mL, the sensitivity was 91% with a specificity of 81%; a CRP cut-off value at 172 mg/L yielded a sensitivity of 81% with a specificity of 76%. Conclusion PCT and CRP measurement on admission and during the course of the disease in patients with COVID-19 may be helpful in identifying secondary bacterial infections and guiding the use of antibiotic therapy.

The significance of ferritin as one of the markers of inflammation

2022 ◽  
pp. 29-33
Author(s):  
Aleksey Borisovich Petrukhin ◽  
Keyword(s):  
Iron Deficiency ◽  
The Body ◽  
Laboratory Diagnostics ◽  
C Reactive Protein ◽  
Viral Etiology ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Important Trace Element ◽  
Pro Inflammatory Cytokines

Iron is an extremely important trace element that plays a large role in oxygen transport, DNA synthesis and muscle tissue metabolism. Ferritin is a protein compound inwhich iron is deposited as a reserve for the body; in laboratory diagnostics, it is usually evaluated as a marker of iron content, and the determination of its concentration is used to diagnose iron deficiency conditions. It structurally consists of the protein apoferritin and the ferric atom in the composition of phosphate hydroxide. One ferritin molecule can contain up to 4,000 iron atoms. The ferritin content in blood is measured in nanograms per milliliter. The normal concentration for men is 29–397 ng/ml, and for women, it is 6–159 ng/ml. A decrease in the level of ferritin in the blood is possible in iron deficiency, but an increase in its concentration may indicate not only the development of hemochromatosis, but also, along with C-reactive protein, be a marker of an active inflammatory reaction. An increase in the synthesis of C-reactive protein, fibrinogen, ferritin, serum amyloid by hepatocytes occurs under the influence of pro-inflammatory cytokines IL-6, IL-18, IL-1, TNF in severe acute processes, especially in the case of their viral etiology.

scholarly journals Monitoring Antibiotics and Inflammatory Markers in Human Blood: Impact in Choice of Antibiotic Therapy and Used Methods

2019 ◽  
Author(s):  
Anna N. Berlina ◽  
Anatoly V. Zherdev ◽  
Boris B. Dzantiev
Keyword(s):  
Antibiotic Therapy ◽  
Inflammatory Markers ◽  
Bacterial Infections ◽  
Comparative Assessment ◽  
Modern World ◽  
Pathogenic Microorganisms ◽  
C Reactive Protein ◽  
Basic Principles ◽  
Reactive Protein ◽  
Antibiotic Drugs

In the modern world, the problem of antibiotic therapy is acute. Despite the diversity of existing antibiotic drugs, their efficacy decreases as new, resistant forms of pathogenic microorganisms emerge. It is extremely difficult to control such processes and even more difficult to treat severe bacterial infections. In such situations, an individual approach to each patient is required and physicians need parameters to estimate the efficacy of antibiotic therapy. This review discusses the significance of monitoring the content of antibiotics in the blood for this purpose, in combination with the content of inflammatory markers, such as C-reactive protein and procalcitonin. The basic principles of antibiotic therapy, and factors in the resistance of microorganisms to antibiotics, are examined. Approaches to assess the efficacy of antibiotic therapy, as well as methods to detect antibiotics and inflammatory markers in the blood of patients, and comparative assessment of their capabilities and limitations, are described.

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