PCT Levels Research Articles

Procalcitonin levels in children affected by severe malaria compared to those with uncomplicated malaria in the absence of bacterial infection: a cross-sectional study

BackgroundProcalcitonin is an inflammatory marker strongly associated with the presence of bacterial infection. It has been considered raised in severe malaria infection as opposed to uncomplicated malaria. There are suggestions that it may be raised only when there is concomitant unnoticeable bacterial infection during a malaria crisis. We aimed to assess the difference in plasma procalcitonin levels between children affected by severe and uncomplicated malaria.MethodsWe assessed plasma procalcitonin levels in 83 children diagnosed with malaria with no clinical and biological evidence of concomitant bacterial infection. Severity of malaria was established using WHO guidelines. Procalcitonin was determined using the ELISA method. Non-parametric Mann-Whitney U test was used to compare medians across the 2 groups. Statistical significance was set for all p values < 0.05.ResultsOf the 83 participants, 28 had uncomplicated malaria, and 55 had severe malaria. PCT levels were obtained in 24 and 40 subjects of each group, respectively, and were similar in both groups; [2.76 (2.52–2.93) vs 2.74 (2.52–2.98) ng/ml, p = 0.916]. The parasite density was lower in the uncomplicated malaria group than in the severe malaria group, but not statistically significant; [22,192 (9110–44 654) vs 31 684 (13 960–73 500) parasites/μl, p = 0.178]. There was no correlation between the parasite density in the general study population and PCT levels (r = 0.072, p = 0.572).ConclusionIn the absence of overt bacterial infection, procalcitonin levels are not different between children affected with uncomplicated malaria and those with severe malaria. Therefore, bacterial infection should be thoroughly checked for in children with raised serum procalcitonin diagnosed with severe malaria.

Bilateral paralysis of peroneal nerve after COVID-19 disease: a case report

BackgroundCOVID-19, caused by a novel coronavirus SARS-CoV 2 has rapidly developed into pandemic. This infectious disease affecting mainly respiratory system may cause multiple systemic disorders. With increasing number of new infected patients there are more and more cases with neurological complications secondary to COVID-19.Case presentationHere we present a case of 67-years old Polish male with previously no comorbidities, who has developed bilateral paralysis of peroneal nerve after SARS-CoV 2 infection. Prior to the hospitalization he presented cough and fever and weakness. RT-PCR was reported positive for COVID-19 infection. Then he developed pneumonia and respiratory failure with bilateral lung consolidations on radiological examination. Laboratory findings revealed elevated levels of D-dimer, CRP, AspAT, GGTP, PCT and serum glucose. After discharge from hospital he was diagnosed with thrombophlebitis and prediabetes on follow-up visits. Due to problems with walking, numbness of toes and involuntary muscle spasms in hands, the patient went to the Neurological Outpatient Clinic. After neurological examination bilateral paralysis of peroneal nerve was revealed.ConclusionsIn this report we want to highlight one of the unexpected presentations of SARS-CoV 2 infection and emphasize the importance of neurological examination in COVID-19 patients.

Effects of Gegen Qinlian Decoction combined with Chinese herbal hot package on the expression of PCT, CRP and IL-6 in patients with acute gastroenteritis.

This study was carried out to investigate the clinical efficacy of Gegen Qinlian Decoction combined with a Chinese herbal hot package in the treatment of acute gastroenteritis (AGE), and to analyze the effects on serum PCT, CRP and IL-6 levels. For this purpose, 100 patients with AGE admitted to the hospital from January 2019 to January 2022 were selected for the study and randomly divided into observation and control groups, with 50 cases in each group. Patients in the control group were given conventional Western medical treatment, while patients in the observation group were treated with Gegen Qinlian Decoction combined with a Chinese herbal hot package on this basis. The clinical efficacy, symptom relief time, main symptom scores and serum PCT, CRP and IL-6 levels before and after treatment were compared between the two groups. Results showed that the total effective rate of patients in the observation group was significantly higher than that in the control group (P<0.05). After treatment, the disappearance time of diarrhea, abdominal pain, fever and vomiting was significantly shorter in the observation group than in the control group (P<0.05). After treatment, the stool properties, number of stools and abdominal pain symptom scores of patients in both groups were lower than those before treatment, and the symptom scores of patients in the observation group were lower than those in the control group (P<0.05). The PCT, CRP and IL-6 levels of patients in both groups were significantly lower after treatment than before treatment, and the PCT, CRP and IL-6 levels of patients in the observation group were significantly lower than those in the control group (P<0.05). It was concluded that the clinical efficacy of Gegen Qinlian Decoction combined with Chinese herbal hot package in the treatment of AGE is remarkable, which can effectively improve the clinical symptoms and reduce the inflammatory reaction of patients and is worthy of clinical promotion.

Influence of extracorporeal cytokine adsorption on hemodynamics in severe acute pancreatitis: Results of the matched cohort pancreatitis cytosorbents inflammatory cytokine removal (PACIFIC) study.

Outcome of severe acute pancreatitis (SAP) highly depends on the degree of systemic inflammation and organ failure. Although treatment approaches targeting the inflammatory cascade have failed in pancreatitis, recent studies suggest that extracorporeal cytokine adsorption effectively reduces concentrations of pro-inflammatory cytokines and potentially improves the outcome of sepsis. Sixteen patients with SAP, presenting within 7days upon onset of pain, an APACHE-II score of ≥10 and ≥1 marker of poor prognosis, received 2 consecutive 24-h treatments with CytoSorb® extracorporeal cytokine adsorption (intervention group). Hemodynamics, organ failure, and mortality were compared with an APACHE-II score-matched retrospective control group of 32 patients. The primary objective (20% decrease in the vasopressor dependency index or 20% increase in the cardiac index) was reached in 68.8% of the intervention and 28.1% of the control patients (p=0.007), respectively. The cytokine adsorption significantly reduced IL-6 (-1998pg/ml, p=0.005) serum levels and resulted in stable CRP (p=0.101) and decreased PCT (p=0.003) levels in contrast to increased CRP (p=0.014) and stable PCT levels (p=0.695) in the control group. While mortality and improvement of respiratory failure were similar in both groups, renal failure significantly improved (change of KDIGO classification 72h postcytokine adsorption [-1 vs. 0, p=0.005]) and the SOFA score significantly decreased (day 5: -1.8±2.0 vs. 1±3.8, p=0.013) in the intervention group. Cytokine adsorption might be an effective treatment option to stabilize hemodynamics in SAP. It decreases levels of the pro-inflammatory marker IL-6 and stabilizes organ function according to serial SOFA score assessments.

Specific Combinations of Inflammatory, Angiogenesis and Vascular Integrity Biomarkers Are Associated with Clinical Severity, Coma and Mortality in Beninese Children with Plasmodium Falciparum Malaria.

Malaria-related deaths could be prevented if powerful diagnostic and reliable prognostic biomarkers were available to allow rapid prediction of the clinical severity allowing adequate treatment. Using quantitative ELISA, we assessed the plasma concentrations of Procalcitonin, Pentraxine-3, Ang-2, sTie-2, suPAR, sEPCR and sICAM-1 in a cohort of Beninese children with malaria to investigate their potential association with clinical manifestations of malaria. We found that all molecules showed higher levels in children with severe or cerebral malaria compared to those with uncomplicated malaria (p-value < 0.005). Plasma concentrations of Pentraxine-3, Procalcitonin, Ang-2 and the soluble receptors were significantly higher in children with coma as defined by a Blantyre Coma Score < 3 (p < 0.001 for Pentraxine-3, suPAR, and sTie-2, p = 0.004 for PCT, p = 0.005 for sICAM-1, p = 0.04 for Ang-2). Moreover, except for the PCT level, the concentrations of Pentraxine-3, suPAR, sEPCR, sICAM-1, sTie-2 and Ang-2 were higher among children who died from severe malaria compared to those who survived (p = 0.037, p = 0.035, p < 0.0001, p= 0.0008, p = 0.01 and p = 0.02, respectively). These findings indicate the ability of these molecules to accurately discriminate among clinical manifestations of malaria, thus, they might be potentially useful for the early prognostic of severe and fatal malaria, and to improve management of severe cases.

Cytokine adsorption in patients with post-cardiac arrest syndrome after extracorporeal cardiopulmonary resuscitation (CYTER) – A single-centre, open-label, randomised, controlled trial

AimTo investigate the effect of cytokine adsorption in patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) after cardiac arrest. MethodsCYTER was a single-centre, open-label, randomised, controlled trial. Patients selected for ECPR at the University Medical Center Freiburg (Freiburg, Germany) were assigned to extracorporeal membrane oxygenation (ECMO) support with or without cytokine adsorption (1:1) using the CytoSorb adsorber, incorporated into the ECMO, replaced every 24 hours, and removed after 72 hours. The primary endpoint was serum interleukin (IL)-6 concentration at 72 hours (intention-to-treat analysis). Secondary endpoints included 30-day survival, vasopressor support and biomarkers of end-organ injury. ResultsOf 50 patients enrolled in the trial, 26 (52%) were treated with cytokine adsorption and 24 (48%) without. Nine patients were excluded (informed consent could not be obtained); 41 patients were therefore included in the primary analysis. Median IL-6 levels (IQR) decreased from 408.0(93.4–906.5) to 324.0 (134.3–4617.3) pg/mL and increased from 133.0 (56.2–528.5) to 241.0 (132.8–718.0) pg/mL in the cytokine adsorption and control group, respectively (linear regression for treatment [cytokine adsorption vs control]: p = 0.48). Three (14%) of 22 patients treated with cytokine adsorption and 8 (42%) of 19 patients treated without cytokine adsorption survived to day 30 (HR = 1.85, 95% CI 0.86–4.01; p = 0.10). Vasopressor support and NSE, S100b, troponin T, CRP and PCT levels were similar between groups. ConclusionCytokine adsorption in patients receiving ECPR did not reduce serum IL–6 and had no significant effect on survival, vasopressor support, or biomarkers of injury. Clinical trial registrationClinicalTrials.gov: NCT03685383.

Identification of RAGE and OSM as New Prognosis Biomarkers of Severe Pneumonia.

Objective To investigate efficiency of RAGE and OSM as new prognosis biomarkers of severe pneumonia. Methods Eligible patients were classified into hypoxemia and nonhypoxemia groups. Meanwhile, the same cohort was divided into survival and nonsurvival groups after a post-hospital stay of 30 days. We analyzed risk factors for the hypoxia and death among these patients. Results Compared with nonsurvival group, significant increase was noticed in PH, lymphocyte, albumin and platelet level in survival group, while significant decline was noticed in neutrophils, RBC, hemoglobin, hematocrit, creatinine, total bilirubin, CRP, PCT, OSM, RAGE and neutrophils/lymphocyte level. Oxygenation index level was related to APACHE II, LIS, SOFA, NUTRIC score, WBC, neutrophils, lymphocyte, RAGE, and albumin level (p < 0.05). LIS, SOFA, NUTRIC score, lac, lymphocyte, platelet, BUN, total bilirubin, PCT, and OSM levels were associated with mortality rate (p < 0.05). Conclusions RAGE and OSM may serve as a new biomarker for poor prognosis in pneumonia patients.

Comparison of Cytokine Hemadsorption as an Immunomodulator Therapy in COVID-19 Patients with and without Bacterial Sepsis.

In this retrospective study, we aimed to compare the laboratory and clinical results of cytokine hem-adsorption as an immunomodulation therapy in COVID-19 ICU patients with or without sepsis. The levels of PCT, CRP, and ferritin were determined as indicators of infection/sepsis; the levels of in-terleukins (IL-6, IL-8 and IL-10, and TNF-α) were determined as indicators of cytokine storm were compared. APACHE score, SOFA score, and mortality rates were compared for the progression of the disease in 23 COVID-19 patients. The therapy was generally successful in reducing the levels of IL-6, IL-8, IL-10, and TNF-α but the levels measured after the procedure did not differ among the patients with or without sepsis, suggesting that the presence of sepsis did not affect the efficacy and function of the cytokine hemadsorption procedure in COVID-19 patients. All parameters were reduced after the procedure except the levels of PCT and ferritin and mortality rates of patients diagnosed with sepsis. The level of PCT was significantly higher in these patients compared with the patients without sepsis while the ferritin and mortality did not show any significant difference between the two groups, suggesting that the cytokine hemadsorption may be safe in the treatment of critical COVID-19 patients. As a result, the progression of sepsis in COVID-19 may be avoided with cytokine hemadsorption applied as an immunomodulator therapy. However, this therapy should be further explored and validated prior to its introduction to everyday clinical practice when the epidemic conditions end.

CHARACTERISTICS OF PATIENTS WITH PROCALCITONIN MEASUREMENTS DURING EARLY DIAGNOSIS PROCESS

Aim: To present the population of patients admitted to the Emergency Department in whom their attending physician decided to assess PCT level. Material and methods: All data were collected between 01/04/2022 and 30/04/2022. The inclusion criterion was performed PCT measurement at admission to the Emergency Department. The following data were noted: age, gender, temperature, blood pressure, heart rate, SpO2, respiratory rate, Glasgow Coma Scale, the diagnosis: pneumonia, infection tractus urinary, diabetes, SARS-Cov-2 infection, PCT level, C-reactive protein level, leucocyte level, glomerular filtration rate. PCT upper normal limit was 0.05 μg/L, C- reactive protein upper limit was 5 mg/dL and leucite number was between 4 and 10 G/dL. Results: PCT level was increased in 68 (83%) of the studied group. The patients with increased PCT level are older, have lower blood pressure and more often increased C-reactive protein concentration. These patients tended to have increased in-hospital mortality. Conclusions: PCT level was increased in the majority of patients in whom this parameter was assessed by emergency physicians. Abnormal leucocyte number and the presence of temperature above 37 Celsius degree had no prediction value of presence of increased PCT. Increased PCT level may indicate the increased risk of the in hospital death. Simple guidelines for PCT usage need to be created and implemented in everyday clinical practice.

Clinical effect and prognostic factors of mechanical thrombectomy in the treatment of acute ischemic stroke.

Objectives:To explore the clinical effect and prognostic factors of mechanical thrombectomy in the treatment of acute ischemic stroke.Methods:The records of patients with acute ischemic stroke treated in our hospital from April 2020 to April 2021 were retrospectively selected. A total of 65 patients were treated with mechanical thrombectomy. After treatment, they were scored with modified Rankin Scale (MRS). The treatment effect and prognostic factors were analyzed.Results:The occluded vessels were successfully opened in 65 patients. The recanalization rate was 96.92%. There were no serious complications of thrombectomy. The time from femoral artery puncture to vascular recanalization was (84.06±16.64) minutes and the number of thrombectomies was (2.52±0.71). There were 42 patients with good prognosis and 23 patients with poor prognosis. Analysis of the prognostic factors showed that the time from onset to admission in the good prognosis group was shorter, the NIHSS score before thrombectomy was higher, and the Alberta stroke program early CT Score (ASPECT) score was lower as compared to the patients in the poor prognosis group. The grade of vascular recanalization in the good prognosis group was better than that in the poor prognosis group, and the level of PCT was lower (P<0.05). Logistic regression analysis showed that the time from onset to admission, NIHSS and ASPECT scores before thrombectomy were the prognostic factors of mechanical thrombectomy in the treatment of acute ischemic stroke.Conclusion:Mechanical thrombectomy is effective in the treatment of acute ischemic stroke and can effectively promote the recanalization of occluded vessels, but the NIHSS and ASPECT scores from the onset to the time of admission before thrombectomy can directly affect the prognosis of patients.

Values of PCT and STREM-1 combined with clinical pulmonary infection score for the prognostic evaluation of elderly patients with ventilator-associated pneumonia

Abstract Objective: To explore the values of PCT and STREM-1 combined with clinical pulmonary infection score (CPIS) for evaluating ventilator-associated pneumonia (VAP) in elderly patients. Methods: A total of 120 eligible patients were selected as VAP group, and 60 other patients without VAP were selected as control group. According to APACHE II scores, VAP group was divided into low-, medium-, and high-risk groups. The correlations of PCT, STREM-1, and CPIS with APACHE II score were analyzed. The values of PCT and STREM-1 combined with CPIS for evaluating prognosis were analyzed using ROC curves. Results: In the VAP group, serum PCT and STREM-1 levels and CPIS after mechanical ventilation significantly exceeded those of the control group and before mechanical ventilation (P&lt;0.05). These values were higher in the high-risk group than in medium- and low-risk groups (P&lt;0.05). They were positively correlated with APACHE II score (P&lt;0.001). These values of the death group were significantly higher than those of the survival group 1, 3, 5, and 7 d after treatment (P&lt;0.05). AUC of PCT and STREM-1 combined with CPIS for assessing prognosis was 0.892 (P&lt;0.001). Conclusions: Serum PCT and STREM-1 levels and CPIS significantly increase in elderly patients with VAP, which rise with aggravation. Their combination has higher values for prognostic evaluation.

A Case-Control Study of Continuous Veno-Venous Hemofiltration Combined with Xuebijing Injection in the Treatment of Severe Sepsis.

A case-control study was conducted to evaluate the efficacy of continuous veno-venous hemofiltration (CVVH) combined with Xuebijing in the treatment of severe sepsis. In order to verify this claim, this study included 100 patients with severe sepsis treated in our hospital from February 2019 to April 2021. The patients were randomly divided into control group and study group. The control group was treated with CVVH, and the study group was treated with CVVH combined with Xuebijing. The curative effect and mortality, NT-proBNP, PCT, Ca∼_(2+), white blood cell count, neutrophil ratio, blood gas analysis, and APACHE-II score were compared between the two groups. The total effective rate of the study group was better than that of the control group (P < 0.05). The fatality rate in the study group was lower than that in the control group (P < 0.05). The levels of NT-proBNP and PCT in the study group were lower than those in the control group, while the level of serum calcium in the study group was higher than that in the control group. After treatment, the white blood cell count (WBC) and neutrophil count in the study group were (13.76 ± 1.28) × 109 shock L and (73.48 ± 1.23)%, respectively, which were significantly lower than those in the control group (17.45 ± 1.36) × 109 shock L and (77.82 ± 1.44)% (P < 0.05). After treatment, the levels of APTT, PT, and DD in the study group were lower than those in the control group. The level of FIB in the study group was significantly higher than that in the control group after treatment. After treatment, the PaO2 and PaO2/FiO2 of the study group were higher than those of the control group, and the APACHE-II score of the study group was lower than that of the control group. CVVH combined with Xuebijing is of positive significance in the treatment of severe sepsis and is worth popularizing.

The relationship of lipid profile with severity of disease and mortality in patients with COVID-1.

Serum total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol may be associated with a poor prognosis in COVID-19 patients. We think it may be essential to understand the role of lipids in the pathophysiology of COVID-19. One hundred eighty-nine patients admitted to the emergency department between 20th January and 20th February 2021 and later decided to be hospitalized to an inpatient clinic or intensive care unit were included in the study. The patients were determined to be hospitalized to the inpatient clinic or intensive care unit according to the Turkish Ministry of Health COVID-19 guidelines. A demographic information form was established for each patient. The primary findings we have obtained were as follows: (1) CRP, PCT, D-Dimer levels were found to be high, while Albumin, TC, HDL-c, and LDL-c levels were found to be low in critical type patients; (2) CRP, PCT, and D-Dimer levels were higher in the patients who were intubated compared to those who were not intubated. Albumin and HDL levels were low; (3) DH was found to have a significantly negative relationship with TC and HDL-c, and (4) Sensitivity of LDL-c in predicting mortality was found as 69 % and specificity as 70 %. It was observed that patients with low LDL-c levels had higher mortality rates. We think that hypocholesterolaemia may be an indicator of the impending danger. Our study examined COVID-19 in terms of lipid metabolism and offers a different perspective on the disease (Tab. 4, Ref. 23). Text in PDF www.elis.sk Keywords: COVID-19, lipid, mortality.

A Corrective Method for Different Hematocrit Values of Whole Blood Samples on the Detection of Procalcitonin.

We have explored that quantitative PCT detection can be conducted in different sample types (whole blood and/or plasma samples) with good correlation and consistency in clinical use. These findings reduce the sample volume and turnover time of PCT detection in clinical labs. However, different hematocrit (HCT) percentages of whole blood samples may affect the final results, especially abnormal hematocrit (HCT) percentages. To overcome this problem, we established a mathematical model to modify the whole blood test results and evaluated the effects of HCT correction. First, we prepared a preliminary experiment - various hematocrit (HCT) percentages (15% - 65%) of whole blood samples with different PCT concentrations and established a mathematic model to correct the effects of PCT detection. Then, in this paper, we evaluated the consistency with Pearson's correlation and Kappa analysis between whole bloods detected by the i-Reader S system and plasma detected by the Biomerieux system. Besides, we prepared different HCT values about 15%, 40%, 60% of 9 samples with different PCT concentrations to evaluate the effects of HCT correction Results and Conclusions: Pearson's correlative studies and Kappa analysis indicated that PCT levels measured by i-Reader S (plasma & whole blood samples) were comparable to results from the VIDAS system, and HCT correction could improve consistency of PCT detection between whole blood and plasma. Analysis of samples with abnormal HCT values showed that the mathematical correction model could offset the influences of various HCT values.

Assessment of C-reactive protein, procalcitonin and interlukin-6 as diagnostic aid for neonatal infections at a tertiary care center

Introduction and Aim: Neonatal infections are the leading cause of mortality among neonates after prematurity. The importance determining biological markers to be used as a diagnostic test to detect neonatal infections the in early stage of the disease is a challenge. The purpose of this study was to evaluate the usefulness &amp; sensitivity of various serological markers such as serum Procalcitonin, C-reactive protein and chemokine IL-6 for diagnosis of neonatal infections leading to sepsis in new born infants. Materials and Methods: This cross-sectional study was carried out among newborns admitted in neonatal intensive care unit (NICU) and meeting the selection criteria. Samples were collected for blood culture and ELISA was performed for detection of CRP, PCT &amp; IL-6. Results: A total of 300 newborns were included in this study from NICU of which 132 (44%) neonates was found to be blood culture positive. The most frequently isolated organisms were Klebsiella pneumoniae (26.5%), followed by Candida albicans (18.1%). In case of confirmed neonatal sepsis, significant higher levels of CRP, PCT and IL-6 were detected than in cases of probable sepsis. Serum procalcitonin levels exhibit highest sensitivity and specificity as 65.91% and 91.67% respectively. Conclusion: Serum procalcitonin has better diagnostic utility in terms of biological marker for the diagnosis of neonatal infections than C- reactive protein and Interleukin-6.

Production of propionic acid through biotransformation of glucose and d-lactic acid by construction of synthetic acrylate pathway in metabolically engineered E. coli

Construction of an efficient synthetic acrylate pathway in recombinant hosts such as E. coli and lactic acid bacteria should lead to synthesis of an array of products such as propionic acid, β-alanine, α-amino butyric acid and other products. The major bottlenecks impeding the titre of propionic acid, from d-lactate via the acrylate pathway in Escherichia coli and Lactococcus lactis, mainly include regulatory hurdles, inefficiency of enzymes involved in production and inability to overexpress multiple enzymes in soluble functional form along with other factors. In this work, the three enzymes, propionyl-CoA transferase (Pct) and acryloyl-CoA reductase (Acr) from E. coli, and lactoyl-CoA dehydratase (Lcd) from Megasphaera elsdenii, that possess better kinetic parameters and reduced size, have been recruited based on the insights gained from kinetic modelling of the acrylate pathway. Secondly, a common strategy for functional expression of these pathway enzymes has been demonstrated to improve their specific activities. The expression levels of Pct, Acr and Lcd were enhanced by sorbitol-induced native folding, with exposure to heat and low expression temperature, resulting in 11-, 4- and 4-fold higher yield of soluble protein than in the control. The specific activities of Pct and Acr were 39- and 34-fold higher than Clostridium propionicum counterparts. Also, the enzyme activity of Lcd was equivalent to that in the native producer, C. propionicum. The recombinant strains exhibited 11% and 20% lesser growth rates than in the control with propionate titre of 240 mg/L and 320 mg/L when grown in glucose and d-lactate, respectively. The yields of propionic acid from glucose and lactic acid were 5% and 32%, respectively. Further improvement in yields should be achieved by expressing all the enzymes in sufficient amount and appropriate ratios, overcoming all the regulatory hurdles.

The Impact of the FilmArray-Based Detection of Microbial Pathogens from Positive Blood Culture Vials on the Time to Optimal Antimicrobial Regimen in Intensive Care Units of the Helios University Clinic Wuppertal, Germany.

The role of empirical therapy and time to first effective treatment, including the antimicrobial stewardship program, are decisive in patients presenting with bloodstream infections (BSI). The FilmArray® Blood Culture Identification Panel (FA BCID 1.0) detects 24 bacterial and fungal pathogens as well as 3 resistance genes from positive blood cultures in approximately 70 min. In this paper, we evaluate the impact of the additional FA BCID analysis on the time to an optimal antimicrobial therapy and on the length of stay in the ICU, ICU mortality, and PCT level reduction. This retro-/prospective trial was conducted in BSI patients in the ICU at a German tertiary care hospital. A total of 179 individual patients with 200 episodes of BSI were included in the prospective intervention group, and 150 patients with 170 episodes of BSI in the retrospective control group. In the intervention group, BSI data were analyzed including the MALDI-TOF MS (matrix assisted laser desorption ionization time-of-flight mass spectrometry) and FA BCID results from January 2019 to August 2020; the data from the control group, including the MALDI-TOF results, were collected retrospectively from the year 2018. The effective and appropriate antimicrobial regimen occurred in a median of 17 hours earlier in the intervention versus control group (p = 0.071). Furthermore, changes in the antimicrobial regimens of the intervention group that did not immediately lead to an optimal therapy occurred significantly earlier by a median of 24 hours (p = 0.029). Surrogate markers, indicating an earlier recovery of the patients from the intervention group, such as length of stay at the ICU, duration of mechanical ventilation, or an earlier reduction in PCT level, were not significantly affected. However, mortality did not differ between the patient groups. A postulated reduction of the antimicrobial therapy, in those cases in which coagulase-negative Staphylococcus species were identified, did occur in the control group, but not in the intervention group (p = 0.041). The implementation of FA BCID into the laboratory workflow can improve patient care by optimizing antimicrobial regimen earlier in BSI patients as it provides rapid and accurate results for key pathogens associated with BSI, as well as important antimicrobial resistance markers, e.g., mecA or vanA.

466 The role of pulmonary act in the patient with SARS-CoV-2 infection

Already from the first data in China in early 2020 it emerged that patients with cardiovascular comorbidities had an increased risk of contracting SARS-CoV-2 infection and a more unfavourable clinical course. From March to May 2020, 85 patients affected by COVID-19 were enrolled, hospitalized at the Great Metropolitan Hospital of Reggio Calabria. The mean age was 63.6 ± 16.5 years. All patients underwent anamnesis, clinical evaluation, chest CT, ECG and measurement of markers of cardiovascular damage (Troponin I, CK-MB, LDH, D-dimer, BNP) and of inflammation (PCR, IL-6, and PCT). Thirty-one patients underwent echocardiography to look for signs of left ventricular dysfunction and/or repercussions of lung disease on the right sections. In particular, we evaluated parietal dimensions and thicknesses, biventricular function and transvalvular tricuspid and pulmonary flows and correlated the data obtained with ECG, radiological, clinical, and biohumoral parameters. The aim of our study was to evaluate the prognostic impact of cardiovascular involvement in COVID-19, investigating the effect of cardiovascular risk factors, levels of cardiovascular damage markers and newly emerging ECG and echocardiographic changes on a composite primary endpoint, consisting of the combination of exitus and the need for intensive care (ICU). For this purpose, the enrolled patients were divided into two subpopulations: those with better prognosis and those with poorer prognosis (ICU/exitus). We then analysed the reciprocal correlation of each of the investigated parameters and searched for the presence of echocardiographic signs of repercussion on the right sections of the pulmonary pathology. Among the patients with the poorest prognosis, 81.2% were hypertensive, 12.5% diabetic, 25% dyslipidaemic. Comparing the two subpopulations analysed, it emerged that patients with the worst prognosis were known hypertensive (P 0.02). Longer QTc intervals were associated with higher levels of CRP (P < 0.0001) and PCT (P 0.005). All markers of cardiovascular damage had significantly higher values in the most critically ill patients (P 0.001 for d-dimer, P < 0.001 for baseline and peak Troponin, P 0.001 for CK-MB, P 0.007 for BNP) and similar behaviour had indices of inflammation (P < 0.001 for PCR and IL-6). Patients with poorer prognosis had significantly lower lung AcT values ( P 0.002), which correlated with higher d-dimer levels (P 0.01) and more complicated hospital stays (P 0.02). There were no statistically significant differences between PAPs, right ventricular size, TAPSE, and pulmonary trunk diameter in the two subpopulations. Larger right ventricular diameters were associated with more dilated lung trunks (P 0.009) and higher IL-6 levels (P 0.004). The most interesting data of our study is the behaviour of pulmonary AcT: lower values of AcT were associated with higher levels of d-dimer, as an expression of a greater pulmonary microthrombotic burden, and a poorer prognosis, in the presence of PAPs basically normal. The dynamic analysis of this parameter, which is easy to calculate in the patient's bed, can play a crucial role in the instrumental follow-up of patients hospitalized for SARS-CoV-2 infection.

356. The Role of Procalcitonin in Antimicrobial Stewardship Among Cancer Patients Admitted with COVID-19

BackgroundProcalcitonin (PCT) has been used to guide antimicrobial therapy in bacterial infections. With the wide spread use of empiric use of antibiotics in cancer patients admitted with COVID-19 disease, we aimed to evaluate the role of PCT in decreasing the duration of empiric antimicrobial therapy among cancer patients admitted with COVID-19. MethodsWe conducted a retrospective study of cancer patients admitted to MD Anderson Cancer Center who had a PCT test done within 72 hours of admission following their COVID-19 diagnosis between March 1, 2020 and June 6, 2021. Patients were divided into 2 groups of PCT < 0.25 ng/mL and PCT >=0.25 ng/mL. We assessed pertinent cultures including blood and respiratory, as well as antibacterial use and duration of empiric antibacterial therapy.ResultsWe identified 544 patients with a median age of 62 years (range, 14-93). There were 312 (57%) patients that had at least one culture obtained from a sterile or infected site within 7 days following admission. None of the patients who had PCT< 0.25 had a positive culture whereas 41/111 (37%) patients with PCT >= 0.25 had at least one positive culture [P< 0.0001]. Among the 373 patients who had a PCT < 0.25, 129 (35%) patients received more than 72 hours of IV antibiotics compared to 87/171 (51%) among patients with PCT >=0.25 [P= 0.0003].ConclusionThese results confirm the correlation between a PCT level greater than 0.25 and a documented bacterial infection. Furthermore, procalcitonin could be useful in enhancing antimicrobial stewardship in cancer patients with COVID-19 by reducing the duration of antimicrobial therapy beyond the initial empiric 72 hours until PCT results become available.Disclosures Natalie J Dailey Garnes, MD, MPH, AlloVir (Other Financial or Material Support, collaborator on research protocol)

Observational case series: six neurosurgical patients with septic shock demonstrating clinical improvement after a combination of standard care and blood purification

BackgroundFor patients with primary brain injury, septic shock is especially dangerous due to the possibility of secondary cerebral damage. The key factor of sepsis-associated brain injury is inflammatory mediators, pathogen and damage-associated molecular patterns (PAMPs, DAMPs) release. Theoretically, blood purification may be beneficial for patients with primary brain injury due to its possibility for fast removal of inflammatory mediators.Case presentationWe report on six post-neurosurgery septic shock patients treated with combined blood purification (CBP), which included CRRT with high adsorption capacity membrane in combination with CytoSorb adsorber. Clinical improvement in the course of CBP was registered in all patients. Three patients had a stable clinical improvement; the other three patients had only a transient improvement due to underlying neurological and cardiac deficits aggravation. We observed septic shock reversal in four patients. The key observations of the case series are a significant decrease in MOF severity (measured by SOFA score) and in catecholamine need (not statistically significant). By the end of CBP we observed a significant decrease in blood lactate, PCT and IL-6 levels. Two patients demonstrated level of consciousness increase in the setting of CBP therapy measured by GCS and FOUR score.ConclusionThis case series demonstrates that CBP therapy may have a role for septic shock patients with primary brain injury.