Diagnosis Of Severe Infection Research Articles

Value of heparin-binding protein in the diagnosis of severe infection in children: a prospective study.

To study the value of heparin-binding protein (HBP) in the diagnosis of severe infection in children. This study was a prospective observational study. The medical data of children who were admitted to the pediatric intensive care unit due to infection from January 2019 to January 2020 were collected. According to the diagnostic criteria for severe sepsis and sepsis, the children were divided into a severe sepsis group with 49 children, a sepsis group with 82 children, and a non-severe infection group with 33 children. The three groups were compared in terms of related biomarkers such as plasma HBP, serum C-reactive protein, serum procalcitonin, and platelet count. The receiver operating characteristic (ROC) curve was plotted to investigate the value of plasma HBP level in the diagnosis of severe infection (including severe sepsis and sepsis). The severe sepsis and sepsis groups had a significantly higher plasma HBP level on admission than the non-severe infection group (P<0.05). Compared with the sepsis and non-severe groups, the severe sepsis group had significantly higher serum levels of C-reactive protein and procalcitonin and a significantly lower platelet count (P<0.05). Plasma HBP level had an area under the ROC curve of 0.590 in determining severe infection, with a sensitivity of 38.0% and a specificity of 82.4% (P<0.05). There is an increase in plasma HBP level in children with severe infection, and plasma HBP level has a lower sensitivity but a higher specificity in the diagnosis of severe infection and can thus be used as one of the markers for the judgment of severe infection in children.

Investigation and analysis of questionnaire on clinical thinking in the diagnosis of severe infection in Guangxi

To understand the clinical thinking of clinical staff in the diagnosis of severe infection and evaluate their ability to recognize severe infection in the early stage. A questionnaire survey was conducted to investigate the clinical thinking of clinical staff attending the academic annual meeting of critical care physicians of Guangxi Medical Doctors Association from September 26 to September 28, 2019. The objects of investigation included doctors, nurses, clinical pharmacists and medical graduate students, except for non-clinical personnel. The basis factors of clinical diagnosis of infection included clinical symptoms, specific biochemical examination, microorganism examination and Next-generation sequencing technology (NGS). The credibility level of each indicator was summarized as high (credibility of 51%-100%) and low (credibility of 0%-50%). Among the more than 600 participants, 540 people participated in the questionnaire survey (participation rate of about 90.0%), and 466 qualified questionnaires (effective rate of 86.3%) were collected, including 280 from doctors, 155 from clinical nurses, 10 from clinical pharmacists and 21 from clinical graduate students. The working years of doctors, nurses, clinical pharmacists and medical graduate students were (8.2±6.0), (6.4±6.3), (4.5±4.0) and (3.8±2.6) years, respectively. The intermediate title (43.2%) dominated in the doctors group, while junior title dominated in the nurses group, clinical pharmacists group and medical postgraduate group (53.5%, 80.0% and 81.0% respectively). Doctors and nurses were mainly from the general intensive care unit (ICU; 73.2% and 51.0% respectively). According to the results of investigation of clinical thinking on the diagnosis of severe infection, there was similar degree of recognition and credibility for infection-related symptoms in the four groups of doctors, nurses, clinical pharmacists and medical graduate students (the credibility of fever was 80.0%-91.1%, low blood pressure 76.2%-90.0%, disturbance of consciousness 80.0%-85.0%, breathing 81.0%-100.0%, reduced of urine 81.9%-90.0%). The interpretation for pathogen culture and NGS results was insufficient because 29.3%-42.6% of the medical staff did not understand NGS. There were differences in the interpretation of the results of pathogen culture (positive specimen culture could diagnose infection; medical vs. nursing vs. pharmacists vs. student: 93.6% vs. 85.2% vs. 90.0% vs. 85.7%, P = 0.021). There were significant differences among the four groups in some traditional infection-related laboratory indexes which included increased white blood cell count (WBC; χ2 = 8.542, P = 0.026), increased C-reactive protein (CRP; χ2 = 8.826, P = 0.024), increased interleukin-6 (IL-6; χ2 = 13.944, P = 0.002), positive 1, 3-β-D glucan detection test (G test; χ2 = 10.988, P = 0.009) and positive galactomannan antigen detection test (GM test; χ2 = 12.306, P = 0.004). There is difference in clinical thinking of diagnosis of severe infection among clinical medical staff in different positions, and the comprehensive diagnostic ability needs to be improved.

Diagnostic value of heparin-binding protein in patients with silicosis complicated by severe infection

Objective: To explore the application value of heparin binding protein (HBP) in the diagnosis of severe infection in patients with silicosis. Methods: A prospective study was conducted on 150 patients with silicosis in the pneumoconiosis department of the General Hospital of Xuzhou Mining Group from January 2017 to March 2018. Among them, 100 were severely infected with silicosis and 50 were non-infected with silicosis. 30 patients were selected in the same period of physical examination as the control group. HBP, C-reactive protein (CRP) , procalcitonin(PCT) , white blood cell count (WBC) , neutrophil percentage, and absolute neutrophil count(ANC) were detected in all participants. Using the receiver operating characteristic curve(ROC) to analyze the diagnostic value of indicator above in patients with different stages of severe silicosis infection. Results: Plasma HBP levels in patients with severely infected silicosis group[(50.39±35.64) ng/ml] were higher than those in the non-infected group[(10.71±1.47) ng/ml] and the control group[(9.24±1.83) ng/ml] (P<0.05) , and with the increase of silicosis stages, there is an increasing trend (P<0.05). The ROC curve showed that the AUC of HBP in the patients with severe silicosis in the first, second, and third stages were 0.932, 0.977, and 0.964, which were higher than those of WBC, CRP, and PCT. Correlation analysis showed that HBP was positively correlated with WBC, CRP and PCT (r=0.711, 0.359, 0.729, P<0.01). Conclusion: HBP has high diagnostic efficacy in the diagnosis of severe infections in patients with silicosis, which may become a clinical screening indicator for severe infections in patients with silicosis and an auxiliary examination indicator for the stage of silicosis patients.

The Role of Pro-Adrenomedullin as a Marker of Severe Bacterial Infection in Children: A Review

Sepsis is still related to high mortality and hospitalization rates in the paediatric population despite medical progress. Prompt recognition of sepsis and consequent initiation of an appropriate treatment are essential elements in securing a positive outcome in adults and children. In such scenario, various biomarkers have been studied to support the clinician in the diagnosis of severe infections, in the identification of patients at risk of progression towards sepsis as well as in the evaluation of the response to treatment. In children, the performance of C-reactive protein and procalcitonin has been largely investigated, whereas data on newer biomarkers of sepsis are scant. The aim of the present review is to summarise the available data on the use of pro-adrenomedullin in the paediatric age.

Early diagnosis of severe infection

Abstract Sepsis is recognised as a global health concern and has a high morbidity and mortality. Evidence shows that mortality rates can be reduced by up to 50% through early recognition and treatment. However, indiscriminate antibiotic use can lead to resistant microbial strains, and increased cost. Sepsis is newly redefined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Screening tools exist and the UK National Institute for Health and Care Excellence (NICE) provide a recommended screening tool which identifies most children at risk from sepsis. Current biomarkers do not reliably differentiate between sepsis and inflammation, and show a delayed response (12–24 hours) to bacterial infection. Evolving research shows procalcitonin is a biomarker released in response to inflammatory stimuli during bacterial infections, with very high levels produced in sepsis and enables real-time monitoring. This review discusses the new definitions of sepsis, importance of making an early diagnosis with appropriate investigations and future diagnostic advancements.

Comparison of the Diagnostic Power Between Cytokine Pattern and Procalcitonin for Predicting Infection in Pediatric Hematology/Oncology Patients

▪Objectives: Neutropenic fever is very common in chilidren with chemotherapy. Due to the fact that an infection is usually suggested, broad antibiotic therapy is usually administered. However, early diagnosis of the infection is usually difficult and the antibiotic therapy may not be alway appropriate. Furthermore, blood culture is usually negative for those heavily treated patients by antibiotics. So a sensitive biomarker for early recognition of inction is desired. Previous studies have shown that procalcitonin (PCT) is a good marker for predicting infection. However, in our experience, the sensitivity of infection recognition by PCT is low. Our previous studies have shown that cytokine profiles presented very high sensitivity and sepecificity for predicting infection in hematology-oncology children at the time of neutropenic fever. However, the diagnositic power between cytokine profiles and PCT in those patients has not been systemically compared. The aim of this study was to evaluate the diagnostic power of the cytokine pattern and serum PCT level for predicting infection in pediatric hematology/oncology patients.Methods: In this retrospective study, a total of 3023 samples (2819 febrile episodes and 204 control samples) derived from 992 (including 164 afebrile patients as control) hospitalized hematology-oncology children. Th1/Th2 cytokines including Interleukin (IL)-2, Il-4, IL-6, IL-10, Tumor necrosis factor (TNF) α and interferon (IFN) γ were measured by a FACScalibur flow cytometer using cytometric bead array (CBA) techniques. According to the etiology, imaging and clinical symptoms, 2819 febrile episodes were divided into 5 groups including blood culture positive sepsis, clinical diagnosed sepsis, non-sepsis infection, viral infection and systemic fungal infection.Results: IL-6 and IL-10 levels as well as positive rates in bacterial infection group were significantly higher than those in viral infection group and control group. In positive blood culture sepsis group, 92.8% (297/320) and 82.2% (263/320) patients had increased IL-6 and IL-10 levels that exceeded the upper limit of the normal range. However, the positive rates of PCT and C-reactive protein (CRP) in bacterial infection group were only 33.8% (108/320) and 73.1%(234/320), respectively, which were significantly lower than those of IL-6 and IL-10 (P<0.01). Based on the receiver operating characteristic (ROC) curves, PCT presented a poorer sensitivity in the diagnosis of severe infection, as compared with IL-6 and IL-10 (p<0.01). As for specificity, IL-6 and IL-10 was also significantly higher than PCT in the diagnosis of Gram-negative bacterial infection.Conclusion: The specific cytokine pattern of highly elevated IL-6 and IL-10 shows higher diagnostic accuracy than PCT for bacterial and severe infection among febrile hematology-oncology children. DisclosuresNo relevant conflicts of interest to declare.

Does procalcitonin, C-reactive protein, or interleukin-6 test have a role in the diagnosis of severe infection in patients with febrile neutropenia? A systematic review and meta-analysis.

The study aims to determine the usefulness of procalcitonin (PCT) and other blood markers for identification of bacterial infection among patients with febrile neutropenia (FN). The Medline, EMBASE, and Cochrane databases were searched for articles from 1966 to December 2012. We performed a search to identify articles that examined the diagnostic accuracy of PCT in patients with FN. Statistical analyses (fixed- or random-effect models) were conducted to summarize and calculate the sensitivity, specificity, likelihood ratios, and 95 % confidence intervals (CIs). Twenty-seven studies were included (1960 febrile episodes) for PCT analysis, 13 (1712 febrile episodes) for C-reactive protein (CRP) analysis, and five (314 febrile episodes) for interleukin (IL)-6 analysis. Increased PCT levels (odds ratio [OR] 11.5; 95 % CI 7.6 to 17.3), raised CRP levels (3.3; 2.7 to 4.2), and raised IL-6 levels (10.0; 5.5 to 18.0) were significantly associated with bacterial infection. Overall positive likelihood ratio was 5.49 (4.04-7.45) for PCT, 1.82 (1.42-2.33) for CRP, and 3.68 (2.41-5.60) for IL-6. Overall negative likelihood ratio was 0.40 (0.31-0.51) for PCT, 0.40 (0.26-0.61) for CRP, and 0.33 (0.23-0.46) for IL-6. Of the three potentially useful markers, PCT had the best positive likelihood ratio and can be used to confirm the diagnosis of bacterial infections in patients with FN. Due to unacceptably high negative likelihood ratio, medical decision for stopping antibiotics based on PCT alone in this high-risk population may not be possible.

Procalcitonin and C-reactive protein in differantiating to contamination from bacteremia

Procalcitonin (PCT) and C-reactive protein (CRP) are important biological markers used in the diagnosis of severe infections. The aim of this study was to evaluate the consistency of blood culture with PCT and CRP in differentiating contamination and non-bacteremia from true bacteremia. In this study blood samples were obtained from 809 febrile patients and analyzed using BACTEC 9120 system. All of positive blood cultures were performed Gram staining. The microorganisms were identified with conventional methods and automated systems. Antibiotic susceptibility tests were made by disc diffusion. PCT levels were analyzed by mini VIDAS device and PCT kit. PCT and CRP levels were analyzed with blood cultures in same times. Kruskal Wallis test, Mann-Whitney U test, Spearman's rho test and ROC curve were used for statistical analyses. The bacteremia group was found to be significantly different from non-bacteremia group and contamination group in terms of both PCT and CRP (p<0.0001). The p values of PCT and CRP in differentiating bacteremia from non-bacteremia were p<0.001 for PCT, p=0.002 for CRP and in differentiating bacteremia from contamination were p<0.001 for PCT, p<0.001 for CRP. PCT is a more useful marker than CRP in the differentiating of true bacteremia from contamination according to the results of this study.

Role of Procalcitonin in the Diagnosis of Severe Infection in Pediatric Patients With Fever and Neutropenia—A Systemic Review and Meta-analysis

The aim of this study was to determine the accuracy of the procalcitonin (PCT) test for diagnosis of bacterial sepsis in pediatric cancer patients with febrile neutropenia. Three major databases, MEDLINE, EMBASE and the Cochrane Library were searched for studies that evaluated the diagnostic value of PCT alone or compared with other laboratory markers such as C-reactive protein (CRP) to identify bacterial sepsis in children with fever and neutropenia. A bivariate model was used to derive summary sensitivity and specificity of the diagnostic tests. A total of 10 studies looking into PCT tests and 8 studies looking into CRP tests were included in the final analysis. The prevalence of bacterial sepsis was 304 of 1031 (29.5%) in PCT studies and 741 of 1316 (56.3%) in CRP studies. In terms of area under the receiver operating characteristic curve, PCT had comparable discrimination to CRP (area under the curve: 0.75 versus 0.74). PCT was not as sensitive as the CRP test. The pooled sensitivity of PCT was 0.59 (95% confidence interval [CI]: 0.42-0.74) as compared with 0.75 (95% CI: 0.61-0.85) for CRP. PCT was more specific than sensitive whereas CRP was more sensitive than specific in this population. The pooled specificity was 0.76 (95% CI: 0.64-0.85) for PCT and 0.62 (95% CI: 0.49-0.73) for CRP. PCT had greater likelihood ratio positive (2.50; 95% CI: 1.64-3.81), making it the better rule-in test. Of three markers potentially useful for diagnosing bacterial sepsis in children with fever and neutropenia, PCT had comparable diagnostic accuracy to CRP.

Compromiso miocárdico en infección grave por virus influenza H1N1

Introduction: During the winter of 2009, some patients infected with Influenza virus H1N1 presented a severe disease. Some isolated reports of myocarditis were described. Objective: To describe severe cases of H1N1 with myocardial involvement. Patients and Methods: Chart review of children between 0-15 y.o. diagnosed as presenting Influenza A H1N1 through Polimerase Chain Reaction, who were admitted to the PICU at Hospital Roberto del Rio and Clinica Davila between June and July of 2009. Myocardial involvement was considered positive if the clinical picture showed such signs, and/or there was an altered echocardiogram. Results: Twenty one patients were hospitalized with the diagnosis of severe Infection by Influenza A H1N1 (+), of which 8 patients (38%) presented myocardial involvement. All required mechanical ventilation. Echocardiogram performed in the first 24 hours post admission showed shortening of the left ventricle on average 21,8%, with a range of 19 to 38%. In 7 patients (87.5%) a systodyastolic dysfunction was shown. Myocardial involvement lasted from 2 to 10 days (median 4). One patient died. Conclusions: Involvement of myocardium is frequent in this series. It must be sought to treat it adequately.

Clinical evaluation of the measurement of serum procalcitonin: comparative study of procalcitonin and serum amyloid A protein in patients with high and low concentrations of serum C‐reactive protein

Levels of C‐reactive protein (CRP) and serum amyloid A protein (SAA) in blood are increased as acute phase proteins in patients with inflammatory conditions. Most of the currently used inflammatory markers, such as erythrocyte sedimentation rate and CRP or SAA levels, are non‐specific parameters. By contrast, procalcitonin (PCT) has been reported to be selectively induced by severe infection in systemic inflammatory response syndrome (SIRS) and also in sepsis or multiorgan dysfunction syndrome. PCT expression is induced only slightly, if at all, by viral infections, autoimmune disorders, neoplastic disorders and trauma arising from surgical intervention. Serum PCT and SAA levels were compared in 93 patients with a CRP concentration higher than 100 mg/L and in 26 patients with a CRP concentration lower than 1.5 mg/L. In patients with high levels of CRP, all patients with sepsis and severe bacterial infection showed a significantly increased PCT concentration of more than 1.0 μg/L and it was possible to differentiate between the patients with neoplastic disorders and those with other inflammatory diseases. In patients with low levels of CRP, the PCT concentration was less than 0.3 μg/L and an increased PCT level was not seen in patients with autoimmune disorders or viral and fungal infections. These results suggest that determining the serum PCT level may be useful in the differential diagnosis of severe infection.

Current Disease Management Strategies in the Treatment of Serious Infections

The diagnosis of severe infection, selection of an appropriate antibiotic to which the most likely pathogens are sensitive, its prompt administration at a sufficient dosage and adequate supportive therapy are critical to ensuring a favourable patient outcome. However, the progressive emergence of strains of microorganisms multiresistant to routinely used antibiotics is causing growing concern and increasing the difficulty of reliably achieving these goals, particularly when these organisms cause serious infections. Resistance is particularly common among organisms such as Pseudomonas aeruginosa and the staphylococci, and is increasingly being encountered in streptococci, enterococci, and Gram-negative bacilli such as Acinetobacter spp., Citrobacter freundii and Serratia spp. Resistance is more likely to appear when such pathogens are exposed to antibiotic concentrations at, above, or slightly below the minimum inhibitory concentration, which may result from inadequate dosages, administration via an inappropriate route, or the presence of bacteria in sequestered sites.

The association of E. coli peritonitis with an impaired and delayed fever response in senescent rats.

Infection is one of the leading causes of death in elderly humans, and the importance of the early diagnosis of severe infection is undisputed. In the elderly a delay in diagnosis is often due to a reduced or absent fever. To understand more fully the pathogenesis of fever in senescence, we assessed the febrile response to E. coli peritonitis in 3-, 12-, and 24-month-old rats. Baseline temperatures were unchanged with age. Following infection with 1 x 10(8) CFU E. coli, a fever was evident in 2.8 h in the young, 3.9 h in the 12-month-old rats, and delayed until 5.8 h in the senescent rats. The magnitude of the fever was quantitatively less in the older rats compared with the two younger age groups throughout the time course of the fever. Because beta-adrenergic-mediated thermogenesis in brown adipose tissue has been implicated in the genesis of fever, we also assessed adenylate cyclase activity in this tissue. There was a progressive age-related decrease in both receptor- and postreceptor-stimulated adenylate cyclase activity. Our findings indicate there is both a delay in the onset of the fever and a reduced febrile response in the senescent rats following E. coli infection.