Ability of procalcitonin to differentiate true bacteraemia from contaminated blood cultures in an emergency department

Iqbal‐Mirza, Sadaf Zafar; Ávila, Vicente Serrano Romero de; Estévez-González, Raquel; Rodríguez-González, Dara; Heredero-Gálvez, Eva; Julián-Jiménez, Agustín

doi:10.1016/j.eimce.2019.06.002

Cited by 5 publications

(22 citation statements)

References 15 publications

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“…Dentro de sus reconocidas utilidades en el paciente con infección en el SUH destaca su capacidad de predecir BV concomitante, incluso con capacidad de predecir la existencia de hemocultivos contaminados [ 14 , 35 ]. Es conocido que existe una relación demostrada entre la mortalidad, la gravedad de situación clínica del paciente de acuerdo con los criterios de sepsis y SS, la confirmación de bacteriemia posterior y los valores de PCT en el momento de la extracción de los HC [ 2 , 5 , 35 ].…”

Section: Biomarcadores: Papel Como Factores Predictivos De Bacteriemiaunclassified

Section: Introductionunclassified

“…La etiología se debe a bacterias grampositivas en un 30-45%, gramnegativas en un 55-70% y anaerobios sobre el 1-3% [5, 6,[12][13][14][15]. Esta proporción puede cambiar, si la incidencia de HC contaminantes fuera excesiva, a favor de las grampositivas [14]. De forma global, las bacterias aisladas con mayor frecuencia de los HC obtenidos en los SUH son Escherichia coli, Streptococcus pneumoniae y Staphylococcus aureus [5,6,[12][13][14][15].…”

Section: Introductionunclassified

“…Esta proporción puede cambiar, si la incidencia de HC contaminantes fuera excesiva, a favor de las grampositivas [14]. De forma global, las bacterias aisladas con mayor frecuencia de los HC obtenidos en los SUH son Escherichia coli, Streptococcus pneumoniae y Staphylococcus aureus [5,6,[12][13][14][15].…”

Section: Introductionunclassified

“…La mortalidad a los 30 días de los pacientes con BV desde el SUH se ha cifrado entre 10-25% [12][13][14][15]. Ésta se relaciona con la gravedad de la situación clínica (existencia de sepsisshock séptico), el tipo de foco primario (urinario, respiratorio, abdominal, sistema nervioso, desconocido) y las características de los pacientes (edad, comorbilidad, situaciones particulares, etc) [18,19].…”

Section: Introductionunclassified

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New predictive models of bacteremia in the emergency department: a step forward

Julián-Jiménez¹,

Rubio-Díaz²,

Castillo³

et al. 2022

Rev Esp Quimioter

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The care of patients with a suspected infectious process in hospital emergency department (ED) has increased in the last decade to account for around 15-20% of all daily care. In the initial evaluation of these patients, samples are taken for the different microbiological studies in 45% of the cases, where obtaining blood cultures (BC) predominates, in 14.6% of all of them. The diagnostic yield of these BC is highly variable (2-20%). The most frequent suspected or confirmed foci or infectious processes of true bacteremia (TB) in the ED are urinary tract infection (45%) and respiratory infection (25%). For all these reasons, the suspicion and confirmation of TB has a relevant diagnostic and prognostic significance and requires changing some of the most important decisions to be made in the ED. Among others, indicate discharge or admission, extract BC and administer the appropriate and early antimicrobial. The intention of this review is to highlight the scientific evidence published in the last five years, clarify the current controversies and compare the ability to predict bacteremia of the latest predictive models published since 2017 with those already existing on that date, year in which a review was published that left open the proposal to continue searching for a model with adequate performance for ED. And so, based on it, generate different recommendations that help define the role that these models or scales can have in improving the indication for obtaining BC, as well as in the immediate making of other diagnostic-therapeutic decisions (administration early and appropriate antibiotic treatment, request for complementary tudies and other microbiological samples, intensity of hemodynamic support, need for admission, etc.)

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Section: Biomarcadores: Papel Como Factores Predictivos De Bacteriemiaunclassified

Section: Introductionunclassified

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New predictive models of bacteremia in the emergency department: a step forward

Julián-Jiménez¹,

Rubio-Díaz²,

Castillo³

et al. 2022

Rev Esp Quimioter

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Profile of Tumor Necrosis Factor Alpha Levels in Childhood Malignancy with Febrile Neutropenia

Sianturi¹,

Wardhani²,

Ugrasena³

2022

Indonesian J. Clin. Pathol. Med. Lab.

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Infection is a significant cause of morbidity and mortality in childhood malignancy with Febrile Neutropenia (FN). Tumor Necrosis Factor-Alpha (TNF-Î±) is involved in host defense against bacterial invasion. However, changes in TNF-Î± levels with the possibility of bacterial infection confirmed by blood culture are still unclear. The study aimed to evaluate TNF-Î± levels in childhood malignancy with FN who had blood cultures with a control group. Observational cross-sectional analysis during January-October 2020 at Dr. Soetomo General Academic Hospital, Surabaya. Childhood malignancy with FN episodes as the case group and nonfebrile neutropenia as the control. TNF-Î± levels examination used plasma with the Enzyme-Linked Immunosorbent Assay (ELISA) sandwich method. Blood culture results were obtained from the patient's medical record. The differences in TNF-Î± levels in the case groups and control were analyzed by the T-square test for two independent samples or Mann-Whitney U according to the data distribution. There were 18 cases group with 30 FN episodes and 15 controls. There were 8(26.66%) positive and 22(73.33%) negative blood cultures from 30 FN episodes. The mean TNF-Î± levels in the positive blood culture cases group and control: 14.72Â±5.77 and 9.78Â±2.74 pg/mL, and the median (min-max) negative blood cultures: 12.19 (7.01-25.70) pg/mL. There was no significant difference in TNF-Î± levels in the positive and negative blood culture cases group (p=0.527), but there was a significant difference in the control (p=0.049 and p=0.027). Therefore, TNF-Î± levels cannot be used as a marker of bacterial infection in the case groups.

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Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

Julián-Jiménez,

Eduardo García,

Merinos-Sánchez

et al. 2023

Rev Esp Quimioter

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Introduction. Obtaining blood cultures (HC) is performed in 15% of the patients treated with suspicion of infection in the Hospital Emergency Services (ED) with a variable diagnostic yield (2-20%). The 30-day mortality of patients with bacteremia is two or three times higher than the rest with the same process. Procalcitonin (PCT) is a biomarker that has been used as a tool to help predict bacteremia in HEDs. The main objective of this systematic review is to investigate the diagnostic accuracy of PCT in predicting true bacteraemia in adult patients treated with clinical suspicion of infection in the ED, as well as to identify a specific PCT value as the most relevant from the clinical decision diagnostic point of view that can be recommended for decision making Method. A systematic review was performed following the PRISMA guidelines in the PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov databases from January 2010 to May 31, 2023 without language restrictions and using a combination of MESH terms: “Bacteremia/ Bacteraemia/ Blood Stream Infection”, “Procalcitonin”, “Emergencies/ Emergency/ Emergency Department” and “Adults”. Observational cohort studies and partially an systematic review were included. No meta-analysis techniques were performed, but the results were compared narratively. Results. A total of 1,372 articles were identified, of which 20 that met the inclusion criteria were finally analyzed. The included studies represent a total of 18,120 processed HC with 2,877 bacteraemias (15.88%). Ten studies were rated as high, 9 moderate and 1 low quality. The AUC-COR of all the studies ranges from 0.68 (95% CI: 0.59-0.77) to 0.98 (95% CI: 0.97-0.99). The PCT value >0.5 ng/ml is the most widely used and proposed in up to ten of the works included in this systematic review, whose estimated mean yield is an AUC-COR of 0.833. If only the results of the 6 high-quality studies using a cut-off point (PC) >0.5 ng/mL PCT are taken into account, the estimated mean AUC-COR result is 0.89 with Se of 77.6% and It is 78%. Conclusions. PCT has a considerable diagnostic accuracy of bacteraemia in patients treated in EDs for different infectious processes. The CP>0.5 ng/ml has been positioned as the most suitable for predicting the existence of bacteraemia and can be used to reasonably rule it out.

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Ability of procalcitonin to differentiate true bacteraemia from contaminated blood cultures in an emergency department

Cited by 5 publications

References 15 publications

New predictive models of bacteremia in the emergency department: a step forward

New predictive models of bacteremia in the emergency department: a step forward

Profile of Tumor Necrosis Factor Alpha Levels in Childhood Malignancy with Febrile Neutropenia

Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

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