Indicator Of Bacterial Infection Research Articles

Analysis of Th1/Th2 Balance and Related Cytokine Changes in the Peripheral Blood of Patients with Multiple Myeloma.

This study aimed to explore the changes in Th cells and cytokines in the peripheral blood of patients with multiple myeloma before and after treatment and at the time of the bacterial infection. In total, 23 newly diagnosed MM patients admitted to the Hospital and 23 healthy individuals were selected as the study group and the control group, respectively. Flow cytometry was used to detect the Th1 and Th2 lymphocytes and cytokines, such as IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, INF-γ, IL-17A, IL-1b, TNF-α, TNF-β, and IL-12P70, in the peripheral blood of the patients at initial diagnosis, before and after treatment, and at the time of the bacterial infection. The Th1% and Th1/Th2 ratio at the time of the initial diagnosis were lower in the MM patients than in the control group, whereas the Th2% at initial diagnosis was higher in the MM patients than in the control group. The levels of IL-6, IL-8, IL-10, and IL-17A at initial diagnosis were higher in the MM patients than in the control group. After 4 cycles of treatment, the Th2% in the patients was lower than before the treatment and the Th1/Th2 ratio in the patients was higher than before the treatment. The Th1% and the levels of IL-6, IL-8, IL-10, and INF-γ increased, while the level of IL-12P70 decreased, when MM patients got a bacterial infection. The abovementioned differences were statistically significant (p < 0.05). The Th1/Th2 deviation affects the immune function of the MM patients. There were significant changes in the Th1 and Th2 lymphocytes and cytokines in newly diagnosed MM patients after the treatment. The changes in the Th lymphocytes and cytokines may be an indicator of bacterial infection.

Is procalcitonin elevation always an indicator of bacterial infection?

Is procalcitonin elevation always an indicator of bacterial infection?

Recent Practice Patterns and Variations in Children Hospitalized for Asthma Exacerbation in Japan

Background: High antibiotic prescribing rates for adults with an asthma exacerbation have been reported in developed countries, but few studies have assessed the variation of antibiotic and adjunctive treatment in the routine care of children. Objective: We evaluated the trends in health resource utilization for children hospitalized for asthma exacerbation, ascertained the variations of practices across hospitals and geographic location, and classified these different patterns at hospital levels. Methods: Using data on Japanese children hospitalized for asthma exacerbation with no indication of bacterial infection during 2010–2018, we conducted a retrospective observational study to assess the trends in initial treatment patterns and their variations. Mixed-effect generalized linear models were used to investigate the treatment trends. Hierarchical cluster analyses were performed to classify the treatment variations across hospitals. Results: Overall, 54,981 children were eligible for the study. Proportions of antibiotic use decreased from 47.2% in 2010 to 26.9% in 2018. Similarly, utilization of antitussives, antihistamines, and methylxanthine showed decreasing trends over the period, whereas the use of mucolytics and ambroxol increased. These treatment variations were more considerable in hospital levels than in 47 prefecture levels. Hierarchical cluster analyses classified these patterns into 6 groups, mostly based on mediator release inhibitor, ambroxol, and antitussives. Conclusions: Wide variations in antibiotics and adjunctive treatments were observed across hospital levels. Our findings support the improvement in reducing inappropriate antibiotic use and highlight the need for comparative effectiveness research of the adjunctive treatments among children hospitalized for asthma.

Determination of C-reactive protein concentration by the turbidimetric method in diagnostics of viral and bacterial infections

During the flu season that can impair human health, it is difficult to determine whether a patient has a bacterial or viral infection. The C-Reactive Protein marker is one of the markers in laboratory diagnostics that shows inflammatory processes in the body. The purpose of this study was to prove that the CRP marker is an indicator of bacterial infections and that it is presented in higher concentration in patients with bacterial infection than in patients with a viral infection. Therefore it is helpful in the differentiating bacterial infections from viral infections.

Association between early antibiotic treatment and clinical outcomes in children hospitalized for asthma exacerbation

Professional society guidelines recommend against routine early antibiotic use in the treatment of asthma exacerbation without comorbid bacterial infection. However, high antibiotic prescribing rates have been reported in developed countries. We sought to assess the effectiveness of this strategy in the routine care of children. Using data on 48,743 children hospitalized for asthma exacerbation with no indication of bacterial infection during the period 2010 to 2018, we conducted a retrospective cohort study to compare clinical outcomes and resource utilization between children who received early antibiotic treatment and those who did not. Overall, 19,866 children (41%) received early antibiotic treatment. According to the propensity score matching analysis, children with early antibiotic treatment had longer hospital stay (mean difference, 0.21 days; 95% CI, 0.18-0.28), higher hospitalization costs (mean difference, $83.5; 95% CI, 62.9-104.0), and higher risk of probiotic use (risk ratio, 2.01; 95% CI, 1.81-2.23) than children who did not receive early antibiotic therapy. Similar results were found from inverse probability of treatment weighting, g-computation, and instrumental variable methods and sensitivity analyses. The risks of mechanical ventilation and 30-day readmission were similar between the groups or slightly higher in the treated group, depending on the statistical models. Antibiotic therapy may be associated with prolonged hospital stay, elevated hospitalization costs, and high risk of probiotic use without improving treatment failure and readmission. Our findings highlight the need for reducing inappropriate antibiotic use among children hospitalized for asthma.

Extremely high canine C-reactive protein concentrations\u2009>\u2009100\u2009mg/l\xa0\u2013 prevalence, etiology and prognostic significance

BackgroundIn human medicine, extremely high CRP (C-reactive protein) concentrations > 100 mg/l are indicators of bacterial infection and the need of antibiotic treatment. Similar decision limits for septic pneumonia are recommended for dogs but have not yet been evaluated for other organ systems. The aim of the retrospective study was to investigate the prevalence and evaluate dogs with CRP concentrations > 100 mg/l regarding the underlying etiology, the affected organ system and the prognostic significance.ResultsPrevalence of CRP > 100 mg/l was investigated in dogs presented between 2014 and 2015 and was 12%.For evaluation of etiology and organ systems, dogs with CRP > 100 mg/l presented between 2014 and 2016 were enrolled. Dogs were classified into 4 main disease categories, i.e. inflammatory, neoplastic, tissue damage or “diverse”. Diseases were assigned to the affected organ system. If an organ classification was not possible, dogs were classified as “multiple”. 147 dogs with CRP 101–368 mg/l were included and classified into disease categories: 86/147 (59%) with inflammatory etiology (among these, 23/86 non-infectious, 44/86 infectious (33/44 bacterial), 19/86 inflammation non-classifiable), 31/147 (21%) tissue damage, 17/147 (12%) neoplastic (all malignant) and 13/147 (9%) diverse diseases. The affected organ systems included 57/147 (39%) multiple, 30/147 (20%) trauma, 21/147 (14%) gastrointestinal tract, 10/147 (7%) musculoskeletal system, 8/147 (5%) respiratory tract, 7/147 (5%) urinary/reproductive tract, 6/147 (4%) skin/subcutis/ear, 6/147 (4%) central/peripheral nervous system and 2/147 (1%) heart. The disease group (p = 0.081) or organ system (p = 0.17) did not have an impact on CRP. Based on CRP, a detection of bacterial infection was not possible.The prognostic significance was investigated by determining the 3-months survival and hospitalization rate in a subgroup with known outcome. The 3-months survival rate was 46/73 (63%) while the majority 66/73 (90%) of patients was hospitalized.ConclusionsCRP concentrations > 100 mg/l are occasionally seen in a clinic population. They indicate a severe systemic disease of various etiologies with guarded prognosis. Extremely high CRP concentrations do not allow a conclusion of the underlying etiology or an identification of bacterial inflammation.

Diagnostic Value of Procalcitonin in Patients with Heat Stroke

Background: Heat stroke is a life-threatening disease, but there is currently no biomarker to accurately assess prognosis. Objective: To study whether serum procalcitonin (PCT) is an effective biomarker for evaluating the prognosis for patients with heat stroke. Method: Clinical data for 61 patients with heat stroke were retrospectively collected and analyzed. PCT, Acute Physiology and Chronic Health Evaluation (APACHE II) score and Multiple Organ Dysfunction Score (MODS) were calculated within the first 24 hours of admission to the ICU. The ability of PCT, APACHE II score, and MODS score to predict prognosis was assessed using a receiver operating characteristic curve (ROC) and area under the curve (AUC) analyses. Result: There was no statistical difference in the PCT value on admission to the intensive care unit (ICU) (PCT1) between the survivors and non-survivors (3.27 [95% CI 0.15-13.55] vs 0.45 [95% CI 0.13-2.04], p=0.369). ROC curve analysis showed that AUC of APACHE II score and MODS score were 0.932 (95% CI 0.861-1.000), p<0.001 and 0.857 (95% CI 0.744- 0.970), p<0.001, respectively. The AUC of PCT1 was 0.599 (95% CI 0.353-0.846), p=0.370. The dynamic trend of PCT was also not statistically different between the survivor and non-survivor group (p=0.138). Conclusion: PCT and its dynamic trend do not provide a good assessment of the prognosis for patients with heat stroke. An increase in PCT levels at ICU admission is not an indicator of bacterial infection, which should be confirmed by larger future studies.

An Advanced Multifunctional Hydrogel‐Based Dressing for Wound Monitoring and Drug Delivery

Wound management is a major global challenge and poses a significant financial burden to the healthcare system due to the rapid growth of chronic diseases such as diabetes, obesity, and aging population. The ability to detect pathogenic infections and release drug at the wound site is of the utmost importance to expedient patient care. Herein, this study presents an advanced multifunctional dressing (GelDerm) capable of colorimetric measurement of pH, an indicator of bacterial infection, and release of antibiotic agents at the wound site. This study demonstrates the ability of GelDerm to detect bacterial infections using in vitro and ex vivo tests with accuracies comparable to the commercially available systems. Wireless interfaces to digital image capture hardware such as smartphones serve as a means for quantitation and enable the patient to record the wound condition at home and relay the information to the healthcare personnel for following treatment strategies. Additionally, the dressing is integrated within commercially available patches and can be placed on the wound without chemical or physical irritation. This study demonstrates the ability of GelDerm to eradicate bacteria by the sustained release of antibiotics. The proposed technology holds great promise in managing chronic and acute injuries caused by trauma, surgery, or diabetes.

Serum C - Reactive Protein Level and Peripheral Blood Picture in Children with Pneumonia

This cross sectional study aimed to determine the relation between serum C-reactive protein (CRP) levels and peripheral blood picture in children with bronchopneumonia, conducted at the Division of Pulmonology, Sanglah Hospital, Denpasar during 3 months (December 1996 to February 1997). Serum CRP levels, hemoglobin, leukocyte count, neutrophil count and ESR values in 30 cases between 1 month and 4.5 years (20 male and 10 female) were measured. Bronchopneumonia was mostly found in &lt; 1 year old (67%) and with male to female ratio of 2:1. High CRP serum level (&gt;12 microgram/ml) was found in 33% of 30 cases. Anemia was found in 37%, leukocytosis in 50%, increase segment neutrophil ratio in 30%, increase of ESR in 40% and increase of body temperature more than 38°C in 4 7% of the cases. Neutrophilia, increase of ESR and increase of body temperature were found statistically significant difference between the positive CRP and negative CRP group. Most bronchopneumonia patients in this study were probably caused by non bacteria. Neutrophilia, higher ESR and higher body temperature could be used as an indicator of bacterial infection besides the increase of serum CRP levels.

Allergies, antibiotics use, and multiple sclerosis

Background: The associations between allergies, antibiotics use, and multiple sclerosis (MS) remain controversial and their mediating or moderating effects have not yet been examined. We aimed to assess the direct and indirect influences of allergies and antibiotics use on MS development, and their interactions.Methods: A 1:3 matched case–control study was performed using the National Ambulatory Medical Care Survey database from 2006 to 2013 in the USA. Multiple sclerosis was identified based on the ICD-9 code (340.0) in any position. Cases were matched to their controls based on survey year, age, gender, race, payer type, region, and tobacco use. Allergy diseases and antibiotics prescriptions were extracted by ICD-9 code and drug classification code, respectively. Both generalized structural equation model and MacArthur approach were used to examine their intrinsic relationships.Results: The weighted prevalence of MS was 133.7 per 100,000 visits. A total of 829 MS patients and 2441 controls were matched. Both respiratory tract allergies (OR = 0.29, 95% CI: 0.18, 0.49) and other allergies (OR = 0.38, 95% CI: 0.19, 0.77) were associated with a reduction of the risk of MS. Patients with respiratory tract allergies were more likely to use penicillin (OR = 8.73, 95% CI: 4.12, 18.53) and other antibiotics (OR = 3.77, 95% CI: 2.72, 5.21), and those with other allergies had a higher likelihood of penicillin use (OR = 4.15, 95% CI: 1.27, 13.54); however, the link between antibiotics use and MS was not confirmed although penicillin use might mediate the relationship between allergies and MS.Conclusions: The findings supported allergy as a protective factor for MS development. We also suggest antibiotics use might not be a suitable indicator of bacterial infection to investigate the cause of MS.

A Review of the Value of Procalcitonin as a Marker of Infection.

Septicemia is a growing problem within the United States (US), which increases mortality and the cost of care. Procalcitonin is a pro-inflammatory marker that could be useful in the diagnosis of infection. In the past, procalcitonin levels have been evaluated to diagnose sepsis or guide antibiotic therapy, but it was not determined if it would differentiate between sepsis and other causes of inflammation. Studies reviewed here showed procalcitonin to be a useful biomarker as an indication of bacterial infection. Infections can be diagnosed earlier and managed appropriately to avoid progression to septicemia, reduce mortality, and overall medical costs.

Shedding Light on the Nature of Seminal Round Cells.

IntroductionIn this investigation we assess the incidence of round cells (RCs) in semen samples in our infertile patient population and their significance on intracytoplasmic sperm injection (ICSI) cycle outcomes. We also evaluate the usefulness of RCs as indicators of bacterial infection and highlight the origin of this cell-type, as well as its role in the human ejaculate.Patients and MethodsIn a prospective fashion, a total of 4,810 ejaculated samples were included in the study during a period of 24 months. RCs were characterized for white blood cell (WBC) components versus exfoliated germ cells by testing for multiple markers of ploidy as well as protamine assays. Cases displaying ≥ 2 x 106/ml RCs were screened for bacteria. Raw specimens containing RC were processed by peroxidase and other leukocyte assays, specific stains for protamines were used to identify spermiogenic stage, aneuploidy (FISH) assessment was carried out, and the presence of various Sertoli-cell cytoplasmic remnants was analyzed to identify and characterize immature germ cells. The effect of RC on clinical outcome was assessed in specimens used for ICSI.ResultsThe average age of the men involved was 39.2 ± 7 years. Semen samples had a mean concentration of 40.7 ± 31 x 106/ml, motility of 42.6 ± 35%, and morphology of 2.3 ± 2%. RCs were identified in 261 specimens, representing a proportion of 5.4%. Men with RCs had comparable age but lower sperm concentration and morphology than the control group (P<0.001). The aneuploidy rate of 4.3% in RCs group was remarkably higher than the control group (2.3%; P<0.001). Sperm aneuploidy rate positively correlated with the number of RCs (P<0.001). Of 44 men, 17 of them in 18 cycles had up to 1.9 x 106/ml RCs without affecting fertilization and clinical pregnancy rates when compared to controls (n = 365 cycles). In 27 men undergoing 33 ICSI cycles with ≥ 2 x 106/ml RCs, the fertilization rate trended lower and the miscarriage rate was significantly increased (P = 0.05). There was lack of correlation between RC and bacteriological growth. Specific markers indicated that seminal RCs are mostly immature germ cells encased in the remnants of Sertoli cell cytoplasm. Moreover, their modest protamine content and their haploid status confirm that they are post-meiotic. Sequential observation in the same man showed that RC episodes were followed by an amelioration of semen parameters, and interestingly, the episodic occurrence of RCs often coincides with flu season peaks.ConclusionsSeminal RCs are not a marker of infectiousness but rather a transient indicator of spermatogenic insult that possibly occurs in most men following a mild and transient ailment such as the flu.

The chemokine ligand CXCL16 is an indicator of bacterial infection in necrotizing pancreatitis

ObjectivesCurrent guidelines tell us that intervention in severe necrotizing pancreatitis ought to be performed as late as possible. However, when pancreatic necrosis becomes infected, the necrotic tissue needs to be removed. Unfortunately, bacterial infection can only be proven by invasive methods. MethodsNecrotizing pancreatitis with sterile or infected necrosis was induced in mice. Mice serum samples were examined by antibody-based protein array. After identifying candidate proteins that showed strong regulation, the serum concentration of these proteins was examined by sandwich ELISA. Then, human serum samples were collected from patients with mild pancreatitis, severe pancreatitis with and without pancreatic necrosis and patients with microbiologically proven infection of pancreatic necrosis. These serum samples were then analyzed by sandwich ELISA. ResultsIn mice 6 proteins were strongly up-regulated and were further investigated by ELISAs. Of these proteins, CXCL16 and TRANCE (RANKL) concentrations were analyzed in human serum samples. CXCL16 and TRANCE were increased in patients with pancreatic necrosis and abdominal infection. Receiver operated characteristics showed that CXCL16 was superior in predicting infected pancreatic necrosis when compared to C-reactive protein and TRANCE. ConclusionsSerum CXCL16 is increased in severe pancreatitis with infected pancreatic necrosis and identifies patients who benefit from surgical necrosectomy.

Molecular cloning of the duck mitogen-activated protein kinase 1 (MAPK1) gene and the development of a quantitative real-time PCR assay to detect its expression

Mitogen-activated protein kinase 1 (MAPK1) acts as an integration point for multiple biochemical signals, and is involved in a wide variety of biological processes such as cell proliferation and differentiation, transcription regulation, and development. Mitogen-activated protein kinase 1 plays an important role in inducing cell death in bacterial infections. In this study, the duck MAPK1 gene was cloned for the first time from the Cherry Valley duck. Sequence analysis showed that duck MAPK1 cDNA is 1,557 bp long, with an open reading frame of 1,107 bp. It encodes 368 amino acids, with 85.4, 84.5, and 97.3% homology with the human, mouse, and chicken MAPK1 gene, respectively. Furthermore, a SYBR Green quantitative real-time PCR assay was developed to detect duck MAPK1 expression. Following Riemerella anatipestifer infection by virulent strain Yb2, MAPK1 mRNA level increased more than 200-fold in the duck spleens, suggesting that increased duck MAPK1 expression can be used as an indicator of bacterial infection. Our results provide ground work to warrant further studies of the duck MAPK1 gene in bacterial pathogenesis.

Normal behavior of plasma procalcitonin in adolescents undergoing surgery for scoliosis

Surgical site infections are relatively common after spinal deformity surgery. Early detection of deep wound infections is important, since it may allow retention of spinal instrumentation. However, serum C-reactive protein and erythrocyte sedimentation rate may remain elevated for almost 6 weeks, making differential diagnosis of systemic inflammatory response and acute deep bacterial wound infection difficult. Plasma procalcitonin has been suggested to be a useful indicator for bacterial infection. However, there are no studies evaluating behavior of procalcitonin in patients undergoing major spine surgery with instrumentation. A total of 50 consecutive adolescents (37 idiopathic scoliosis and 13 neuromuscular scoliosis, mean age = 15 years at surgery and follow-up time = 21 months (range = 12-29 months)) undergoing scoliosis surgery participated in this prospective follow-up study. White blood cell count, serum C-reactive protein, and plasma procalcitonin levels were measured on the day before surgery, on the day of surgery, and daily thereafter for 1 week. None of the patients developed signs of acute or delayed wound infection during the follow-up period; however, two neuromuscular scoliosis patients developed severe postoperative pneumonia, and their inflammatory parameter data will be reported separately. Plasma procalcitonin levels peaked on the first postoperative day (mean = 0.19 ng/mL, range = 0.04-1.29 ng/mL), and mean values were less than 0.5 ng/mL during the whole first postoperative week, while C-reactive protein remained elevated during the whole first postoperative week (highest mean value = 63.8 mg/L (range = 5-248 mg/L) on third postoperative day). Patients with idiopathic scoliosis had lower C-reactive protein levels (p < 0.05 from first to sixth postoperative day) and lower procalcitonin levels (p < 0.05 from third to seventh postoperative day) than neuromuscular scoliosis patients. Two patients with postoperative pneumonia showed elevated procalcitonin values over the whole postoperative week (22.34 ng/mL and 0.72 ng/mL highest values, respectively). Elevated plasma procalcitonin levels seem useful when excluding acute deep wound infection from systemic inflammatory response.

Should procalcitonin be used as a routine biomarker of bacterial infection?

I read with great interest the article by Chalupa et al. [1]. The authors have conducted a prospective hospital-based study comparing the potential biomarkers used to diagnose infection in subjects with bacterial and viral infection. The authors concluded that only procalcitonin (PCT) demonstrated superiority over the routine parameters in the differentiation of bacterial from viral infections. Based on this, the authors strongly support the use of the PCT serum level as a routine biomarker of bacterial infection. However, there a few points that need to be highlighted in order for the result to be more meaningful. It is not clear why the authors have used bacterial infection of the lungs (community-acquired bacterial pneumonia [CABP]) and urinary tract (urosepsis) to compare with the viral infections in sites other than these (i.e., of the central nervous system [CNS], liver, etc.). For the results to be meaningful and to supplement clinical decision regarding whether to start or withhold antibiotics in an individual case scenario, the authors could have compared the two infections (either bacterial or viral) at these two sites (either CABP or urosepsis) only. CABP would have been better, as urosepsis is not viral. Moreover, though the authors strongly support the use of PCT as a biomarker for bacterial infection, this issue is still debated [2, 3]. In the recent 2009 H1N1 pandemic, a higher PCT threshold was required to discriminate between bacterial and viral pneumonia, suggesting that severe viral pneumonia alone may elevate PCT [4, 5]. In another important study, 22/23 of patients with community-acquired pneumonia (CAP) with positive serology (three being atypical pneumonia and the rest were viral) were given antibiotics per their PCT algorithm [6]. Patients with atypical pneumonia (due to Mycoplasma and Chlamydia) may have low PCT levels [7]. Even patients who were bacteremic from various sources can have lower PCT levels (\0.5 ng/ml), as found in a recent study [8]. As PCT levels are documented to distinguish viral from bacterial meningitis [9, 10], the authors could have compared the PCT levels between viral or bacterial CNS infection (meningitis or encephalitis) instead of CABP or urosepsis. Another important observation that is not even included in the discussion is that, if PCT is a sensitive indicator of bacterial infection, then why there is a significant difference in the levels of PCT between patients with CABP and urosepsis (as both are presumed to be bacterial), as shown in Table 3 of the paper. As the isolated value of PCT in discriminating between bacterial and viral infection is still not clear, advanced molecular diagnostics should possibly be used to validate the ability of the serum PCT in this regard. In addition, such analysis should be able to clarify PCT responses in mixed viral and bacterial infections, which are detailed elsewhere [11]. If both pathogens (viral and bacterial) are identified, PCT levels should assist in the interpretation of the result also (e.g., colonization with one organism ersus infection with another and vice versa). In spite of all these limitations, PCT serum levels have several advantages when compared with the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level as a biomarker for invasive bacterial disease, and I congratulate the authors for adding further data to support the use of PCT in the diagnosis of bacterial infection. R. R. Das (&) Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India e-mail: dr_rashmipgi@yahoo.com

CRP, WBC, absolute value of neutrophil and percentage joint detection infectious diseases in children infection

Objective To explorethe ralue of the peripheral blood C-reactive protein (CRP), white blood cell(WBC) ,neutrophil percentage(N% ) and neutrophil absolute value(N#) joint detection of bacterial infections to differential diagnosis of bacterial infection in children. Methods CRP, White blood cell( WBC),neutrophil percentage( N%) and neutrophil absolute value(N#) joint detection in 1889 cases of pediatric outpatient. Results The highest positive rate of WBC, accounting for 40. 3%, followed by CRP was 20.4%; with four joint identification of indicators of bacterial infection, the positive rate increased to 43.4%, and increased 3.1%. Conclusion CRP, WBC, N% , N # joint detection will help early diagnosis of disease in Children infect, and helpful in differential dianosis of bacterial infections and viral infection. Key words: Positive rate; Infectious disease; CRP; WBC

Acute‐phase proteins as indicators of bacterial infection in patients with cirrhosis

Cirrhosis is associated with elevated levels of acute-phase proteins (APP), irrespective of the presence of infection. This condition limits the clinical application of APP determination in cirrhotic patients with bacterial infections. To weigh the diagnostic value of several APP in cirrhotics with or without bacterial infection, and to correlate them with the clinical outcome. We investigated 88 consecutive cirrhotic patients (67 males, 21 females; range 28-85 years) with mean age (SD) 58.9 (13.8) on admission, according to a standard protocol for infection. We measured the following APP: C-reactive protein (CRP), fibrinogen (FIB), haptoglobin (Hpt), ferritin (Fer), beta2-microglobulin (beta2-mg), C3, C4 and C1 inhibitor. From the 88 patients, 19 (21.6%) had documented infection at the entry based on clinical, radiological and microbiological data. This group of patients did not differ in basic demographics from those without infection. CRP [17.5 (20.7) vs 77.1 (43.9), P<0.001], beta2-mg [4.4 (4.1) vs 5.6 (2.2), P<0.001] and ferritin [461.2 (776.4) vs 825.8 (870), P=0.03] were significantly higher in infection, whereas C3 was significantly lower. No significant differences were noted in the remaining APP levels between the two groups. After receiver operating characteristic curves were fitted, CRP was the best diagnostic test for infection (area under the curve 0.91), followed by beta2-mg, ferritin, FIB, C1 inhibitor, C4, Hpt and C3. Serum CRP is the best test, among the examined APP, to discriminate bacterial infection in cirrhotics. A cut-off value of >55.8 mg/L has high sensitivity (79%) and specificity (96%), with the best diagnostic accuracy (92%).

Procalcitonin in elective colorectal surgery and its predictive value for an early discharge of fast-track patients

Procalcitonin (PCT) is regarded as a specific indicator of bacterial infection. Infectious complications in patients after colorectal surgery are a common cause of morbidity and mortality. The aim of this study was to investigate whether PCT could serve as a negative predictive marker for postoperative complications, and whether in patients with elevated PCT levels a preemptive treatment with the third-generation cephalosporin ceftriaxone is superior to antibiotic treatment starting later on the appearance of clinical signs and symptoms of infection.

High C-Reactive Protein Levels During a Benign Neonatal Outbreak of Echovirus Type 7

Literature associates neonatal enteroviral infections with high morbidity and mortality. The literature also suggests that high C-reactive protein (CRP) levels are indicators of bacterial infection. We report on high CRP levels, not due to bacterial infection, during an outbreak of neonatal echovirus type 7 infections in the fall of 2002, which had no major complications or mortality.