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Procalcitonin and antibiotic

Borja Gomez, Haydee Diaz, Alba Carro, Javier Benito, Santiago Mintegi
OBJECTIVES: To determine the performance of procalcitonin (PCT), C reactive protein (CRP) and absolute neutrophil count (ANC) in identifying invasive bacterial infection (IBI) among well-appearing infants ≤21 days old with fever without source and no leukocyturia. To compare this performance with that in those 22-90 days old. DESIGN: Substudy of a prospective single-centre registry performed between September 2008 and August 2017. SETTING: Paediatric emergency department of a tertiary teaching hospital...
November 29, 2018: Archives of Disease in Childhood
Kevin J Downes, Julie C Fitzgerald, Emily Schriver, Craig L K Boge, Michael E Russo, Scott L Weiss, Fran Balamuth, Sherri E Kubis, Pam Tolomeo, Warren B Bilker, Jennifer H Han, Ebbing Lautenbach, Susan E Coffin, Jeffrey S Gerber
Background: Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. Methods: We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein <4 mg/dL and procalcitonin <1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours...
November 22, 2018: Journal of the Pediatric Infectious Diseases Society
Young Kyung Yoon, Min Ja Kim, Kyung Sook Yang, Soo-Youn Ham
The aim of this study is to evaluate the usefulness of serum procalcitonin (PCT) as a diagnostic biomarker for distinguishing pneumonia from pulmonary edema in patients presenting with pulmonary infiltrates on chest radiography.A comparative study was performed retrospectively in a university-affiliated hospital, from May, 2013 to April, 2015. Adult patients (≥18 years) who showed pulmonary infiltrates on chest radiography and had blood tests with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), PCT, and N-terminal pro-b-type natriuretic peptide (NT-proBNP) on admission were included in the study...
November 2018: Medicine (Baltimore)
Chanaveerappa Bammigatti, Preetham A Reddy, Nandeesha Hanumanthappa, K T Harichandrakumar, Rathinam Palamalai Swaminathan
The local signs and symptoms following snakebites are similar to those of cellulitis caused by bacterial infections. This leads to empirical treatment with antibiotics, which however is not supported by evidence. Procalcitonin (PCT) is a biomarker with good diagnostic accuracy for bacterial infection. We studied serum PCT concentration in 100 patients aged 13 years or more, presenting to the hospital with significant local manifestations (crossing the joint proximal to the bitten wound) within 24 hours after snakebite...
November 19, 2018: American Journal of Tropical Medicine and Hygiene
Zisis Balmpouzis, Eleni Diamanti, Antonios Kritikos, Benoit Guery, Laurent P Nicod
Respiratory tract infections represent a major cause of morbidity and mortality despite the progress made in their diagnosis and treatment. Since the clinical presentation of a viral or bacterial infection is often similar, the identification of a biomarker that could guide the clinician whether or not to introduce an antibiotic therapy is crucial. C-reactive protein and procalcitonin are the most commonly used biomarkers as a diagnostic tool for respiratory tract infections. New biomarkers show promising results for assessing the severity of infection and identifying patients at risk for complications...
November 14, 2018: Revue Médicale Suisse
Michelle M A Kip, Jos A van Oers, Arezoo Shajiei, Albertus Beishuizen, A M Sofie Berghuis, Armand R Girbes, Evelien de Jong, Dylan W de Lange, Maarten W N Nijsten, Maarten J IJzerman, Hendrik Koffijberg, Ron Kusters
BACKGROUND: Procalcitonin (PCT) testing can help in safely reducing antibiotic treatment duration in intensive care patients with sepsis. However, the cost-effectiveness of such PCT guidance is not yet known. METHODS: A trial-based analysis was performed to estimate the cost-effectiveness of PCT guidance compared with standard of care (without PCT guidance). Patient-level data were used from the SAPS trial in which 1546 patients were randomised. This trial was performed in the Netherlands, which is a country with, on average, low antibiotic use and a short duration of hospital stay...
November 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
Hiang Ping Chan, Tow Keang Lim
PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Acute exacerbations of COPD (AECOPD) are major driver for healthcare utilization with each exacerbation begetting the next exacerbation. It is, therefore, important to treat each episode effectively to prevent the next. However, this can be challenging as AECOPD result from complex interactions between host, environment and infective agents. The benefits of starting antibiotics in AECOPD, which are not life-threatening (e...
November 9, 2018: Current Opinion in Pulmonary Medicine
Mark L Metersky, Andre C Kalil
Two recent major guidelines on diagnosis and treatment of ventilator-associated pneumonia (VAP) recommend consideration of local antibiotic resistance patterns and individual patient risks for resistant pathogens when formulating an initial empiric antibiotic regimen. One recommends against invasive diagnostic techniques with quantitative cultures to determine the cause of VAP; the other recommends either invasive or noninvasive techniques. Both guidelines recommend short-course therapy be used for most patients with VAP...
December 2018: Clinics in Chest Medicine
Sarah Sungurlu, Robert A Balk
Biomarkers are used in the diagnosis, severity determination, and prognosis for patients with community-acquired pneumonia (CAP). Selected biomarkers may indicate a bacterial infection and need for antibiotic therapy (C-reactive protein, procalcitonin, soluble triggering receptor expressed on myeloid cells). Biomarkers can differentiate CAP patients who require hospital admission and severe CAP requiring intensive care unit admission. Biomarker-guided antibiotic therapy may limit antibiotic exposure without compromising outcome and thus improve antibiotic stewardship...
December 2018: Clinics in Chest Medicine
Emerson Posadas, Jay Fisher, Kathryn Pade
The presentation of bacterial meningitis can overlap with viral meningitis and other conditions, and emergency clinicians must remain vigilant to avoid delaying treatment for a child with bacterial meningitis. Inflammatory markers, such as procalcitonin, in the serum and cerebrospinal fluid may help distinguish between bacterial meningitis and viral meningitis. Appropriate early antibiotic treatment and management for bacterial meningitis is critical for optimal outcomes. Although debated, corticosteroids should be considered in certain cases...
November 1, 2018: Pediatric Emergency Medicine Practice
Marc A Meier, Angela Branche, Olivia L Neeser, Yannick Wirz, Sebastian Haubitz, Lila Bouadma, Michel Wolff, Charles E Luyt, Jean Chastre, Florence Tubach, Mirjam Christ-Crain, Caspar Corti, Jens-Ulrik S Jensen, Rodrigo O Deliberato, Kristina B Kristoffersen, Pierre Damas, Vandack Nobre, Carolina F Oliveira, Yahya Shehabi, Daiana Stolz, Michael Tamm, Beat Mueller, Philipp Schuetz
Background: Whether procalcitonin (PCT)-guided antibiotic management in patients with positive blood cultures is safe remains understudied. We performed a patient level meta-analysis to investigate effects of PCT-guided antibiotic management in patients with bacteremia overall and stratified based on type of pathogen. Methods: We extracted and analysed individual data of 523 patients with positive blood cultures included in 13 trials (7 studies evaluating patients with acute respiratory illnesses, 6 studies patients with sepsis), in which patients were randomly assigned to receive antibiotics based on PCT levels (PCT group) or a control group...
October 25, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Ann P O'Rourke, Sara A Buckman, David C Evans, Andrew J Kerwin, Emily A Breunig, Daniel E Bütz
BACKGROUND: We have developed a new, non-invasive predictive marker for onset of infection in surgical ICU patients. The exhaled CO2/CO2 ratio, or breath delta value (BDV), has been shown to be an early marker for infection in a proof of concept human study and in animal models of bacterial peritonitis. In these studies, the BDV changes during onset and progression of infection, and these changes precede physiological changes associated with infection. Earlier diagnosis and treatment will significantly reduce morbidity, mortality, hospitalization costs, and length of stay...
October 23, 2018: Journal of Trauma and Acute Care Surgery
Emerson Posadas, Jay Fisher
The presentation of bacterial meningitis can overlap with viral meningitis and other conditions, and emergency clinicians must remain vigilant to avoid delaying treatment for a child with bacterial meningitis. Inflammatory markers, such as procalcitonin, in the serum and cerebrospinal fluid may help distinguish between bacterial meningitis and viral meningitis. Appropriate early antibiotic treatment and management for bacterial meningitis is critical for optimal outcomes. Although debated, corticosteroids should be considered in certain cases...
November 2018: Pediatric Emergency Medicine Practice
Cornelius Engelmann, Thomas Berg
Introduction: Acute-on-chronic liver failure (ACLF) is associated with a high susceptibility to infections leading to complications and poor prognosis. The sensitized immune system overwhelmingly responds to invading bacteria leading to organ damage. After resolution of infection or prolonged disease duration, the phagocytic system becomes irresponsive with a reduced bacterial clearance capacity promoting secondary infection. Methods: This review focuses on the best management strategies for patients with ACLF and infections...
August 2018: Visceral Medicine
Giannoula S Tansarli, Eleftherios Mylonakis
No abstract text is available yet for this article.
October 16, 2018: Annals of Internal Medicine
Tolga Taymaz, Önder Ergönül, Ayda Kebapcı, Rıfat Okyay
OBJECTIVE: The aim was to describe the factors associated with antibiotic use in upper respiratory tract infections (URTI) in the post-pandemic influenza period. METHODS: All consecutive patients who attended the emergency and outpatient departments of a private 265-bed hospital in Istanbul, Turkey with symptoms of an influenza-like illness (ILI) between January and June 2011 were included. RESULTS: Out of 1270 patients, 100 were tested for Streptococcus A infection and 16 (16%) were found to be positive; 36 patients were tested for respiratory syncytial virus and five were found to be positive...
December 2018: International Journal of Infectious Diseases: IJID
Adam T Hill, Philip M Gold, Ali A El Solh, Joshua P Metlay, Belinda Ireland, Richard S Irwin
BACKGROUND: Patients commonly present to primary care services with upper and lower respiratory tract infections, and guidelines to help physicians investigate and treat acute cough due to suspected pneumonia and influenza are needed. METHODS: A systematic search was carried out with eight patient, intervention, comparison, outcome questions related to acute cough due to suspected pneumonia or influenza. RESULTS: There was a lack of randomized controlled trials in the setting of outpatients presenting with acute cough due to suspected pneumonia or influenza who were not hospitalized...
October 6, 2018: Chest
Victor Jeger, Roxana Pop, Farschad Forudastan, Jean Pierre Barras, Markus Zuber, Rein Jan Piso
No abstract text is available yet for this article.
September 24, 2018: Swiss Medical Weekly
Y van der Does, P P M Rood, C Ramakers, S C E Schuit, P Patka, E C M van Gorp, M Limper
OBJECTIVES: The aim was to effectively reduce the unnecessary use of broad spectrum antibiotics in the emergency department (ED), patients with bacterial infections need to be identified accurately. We investigated the diagnostic value of a combination of biomarkers for bacterial infections, C-reactive protein (CRP), and procalcitonin (PCT), together with biomarkers for viral infections, tumour necrosis factor-related apoptosis-inducing ligand (TRAIL), and interferon-gamma-induced protein-10 (IP-10), in identifying suspected and confirmed bacterial infections in a general ED population with fever...
September 28, 2018: Clinical Microbiology and Infection
Thomas Baumgartner, Giedre Zurauskaite, Christian Steuer, Luca Bernasconi, Andreas Huber, Beat Mueller, Philipp Schuetz
Background Sphingolipids - the structural cell membrane components - and their metabolites are involved in signal transduction and participate in the regulation of immunity. We investigated the prognostic implications of sphingolipid metabolic profiling on mortality in a large cohort of patients with lower respiratory tract infections (LRTIs). Methods We measured 15 different sphingomyelin (SM) types in patients with LRTIs from a previous Swiss multicenter trial that examined the impact of procalcitonin-guided antibiotic therapy on total antibiotic use and rates and duration of hospitalization...
September 29, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
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