Prediction of Outcome from Community-Acquired Severe Sepsis and Septic Shock in Tertiary-Care University Hospital in a Developing Country

Grozdanovski, Krsto; Milenkovic, Zvonko; Demiri, Ilir; Spasovska, Katerina

doi:10.1155/2012/182324

Cited by 24 publications

(34 citation statements)

References 28 publications

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“…Gram-positive pathogens are implicated in Ͼ50% of all bacterial bloodstream infections, with coagulase-negative staphylococci (CoNS) being the most common Gram-positive bacteria isolated from blood culture, followed by Staphylococcus aureus and Enterococcus spp. (2)(3)(4). Similar findings have been demonstrated in our institution where approximately 64% of all positive blood cultures consist of Gram-positive organisms.…”

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confidence: 87%

Performance of the Verigene Gram-Positive Blood Culture Assay for Direct Detection of Gram-Positive Organisms and Resistance Markers in a Pediatric Hospital

et al. 2014

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The performance characteristics of the Verigene Gram-positive blood culture (BC-GP) assay were evaluated in pediatric patients. Concordance of the BC-GP assay was 95.8%, with significant decreases in turnaround time for identification and resistance detection. BC-GP is highly accurate and can be integrated into the routine workflow of the microbiology laboratory. Bloodstream infections are one of the leading causes of death in the United States, and prompt initiation of appropriate antimicrobial therapy is essential to significantly improve patient management and reduce the rate of mortality of bacteremic patients (1). Gram-positive pathogens are implicated in Ͼ50% of all bacterial bloodstream infections, with coagulase-negative staphylococci (CoNS) being the most common Gram-positive bacteria isolated from blood culture, followed by Staphylococcus aureus and Enterococcus spp. (2-4). Similar findings have been demonstrated in our institution where approximately 64% of all positive blood cultures consist of Gram-positive organisms. The workup of pathogens in the clinical microbiology laboratory is a key contributing factor in overall mortality rate, as delays in identification and susceptibility testing have been demonstrated to directly impact patient survival (5). Previous studies have been fundamental in directly correlating rapid identification of Gram-positive pathogens with improved patient outcome, decreased hospital length of stay, and decreased hospital costs (6-9). Moreover, direct detection of the mecA gene in methicillin-resistant S. aureus (MRSA) has been demonstrated to be an effective tool for managing vancomycin usage as well as reducing both hospital length of stay and costs (10, 11).The Verigene Gram-positive blood culture (BC-GP) assay (Nanosphere Inc., Northbrook, IL) is a microarray-based, multiplexed, molecular assay approved by the Food and Drug Administration (FDA) for rapid detection and identification of 12 Gram-positive targets (S. aureus, Staphylococcus epidermidis, Staphylococcus lugdunensis, Staphylococcus spp., Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus anginosus group, Streptococcus pneumoniae, Streptococcus spp., Enterococcus faecium, Enterococcus faecalis, Listeria monocytogenes) and 3 resistance markers (mecA, vanA, vanB). Four recent studies have evaluated the performance of the BC-GP assay on different bottle types (12-15). Specifically, Sullivan et al. reported high sensitivity and specificity in pediatric patients using BacT/Alert pediatric FAN (PF) blood cultures (14). This study evaluated the performance characteristics of the BacT/Alert standard aerobic (SA) noncharcoal and PF charcoal blood culture bottles collected from pediatric patients admitted to Children's Hospital Los Angeles (CHLA), a freestanding pediatric tertiary care center. The implementation process and comparison of workflow and turnaround time (TAT) were also assessed. A total of 203 positive blood cultures (104 SA, 99 PF) from 203 pediatric patients submitted for routine workup to th...

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confidence: 87%

Performance of the Verigene Gram-Positive Blood Culture Assay for Direct Detection of Gram-Positive Organisms and Resistance Markers in a Pediatric Hospital

et al. 2014

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“…Intensive care unit (ICU) patients are at risk for dying of severe bacterial infection such as pneumonia or urinary tract infection that can lead to sepsis [1]. Nosocomial pneumonia is the second-most common infection, affecting 64% of all critically ill patients [2]; 86% of all nosocomial pneumonias are associated with mechanical ventilation as ventilator-associated pneumonia (VAP).…”

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confidence: 99%

CD64 index on neutrophils can diagnose sepsis and predict 30-day survival in subjects after ventilator-associated pneumonia

Muzlovič

Ihan

Stubljar

2016

J Infect Dev Ctries

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Introduction: Sepsis associated with ventilator-associated pneumonia (VAP) causes mortality in intensive care unit (ICU) patients. The time of diagnosis is crucial, and microbiological cultures take time. In this study, the diagnostic accuracy of CD64 index to predict VAP-induced sepsis and survival time in subjects requiring mechanical ventilation were evaluated and compared to conventional biomarkers and culturing methods. Methodology: A total of 32 subjects with VAP were included. Sepsis after VAP was diagnosed in 25 (78.1%) patients according to clinical signs, radiographic examination, and samples of blood and trachea taken for culturing. Simultaneously with cultures, CD64 index on neutrophils, C-reactive protein (CRP), procalcitonin (PCT), and count of leucocytes and neutrophils were determined. Results: Biomarker values were evaluated in both groups of subjects (with and without sepsis after VAP). The values of CD64 index and CRP were significantly higher in the sepsis group. Receiver operating characteristic (ROC) curve analysis revealed an area under curve (AUC) of 0.929 for CD64 index in differentiating subjects with VAP-induced sepsis from those without sepsis. The biomarkers CRP and PCT showed comparable results (AUC of 0.869 and 0.909, respectively). Blood cultures were positive in 12 subjects, endotracheal aspirate in 19. CD64 index and isolation of pathogen with positive blood cultures or from endotracheal aspirate (positive in 24 cases) could predict survival time before application of more targeted antibiotic therapy. Conclusions: CD64 index may be used as a useful diagnostic tool to recognize VAP-induced sepsis; moreover, accompanied with an identified pathogen, can predict survival for ICU patients.

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“…The most prevalent causes of bacterial BSIs are the Gram-positive bacteria (GPB; 30-50 % of all cases), followed by Gram-negative bacteria (GNB) in 25-30 % of sepsis cases and fungal infections in 1-3 % of all sepsis cases (Grozdanovski et al, 2012). Especially, the staphylococci are the most common GPB in blood cultures.…”

Section: Introductionmentioning

confidence: 99%

Comparison of multiplex real-time PCR and PCR-reverse blot hybridization assay for the direct and rapid detection of bacteria and antibiotic resistance determinants in positive culture bottles

Wang¹,

Kim

et al. 2016

Journal of Medical Microbiology

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The aim of this study was to evaluate the performance of a commercially available multiplex real-time PCR assay and a PCR-reverse blot hybridization assay (PCR-REBA) for the rapid detection of bacteria and identification of antibiotic resistance genes directly from blood culture bottles and to compare the results of these molecular assays with conventional culture methods. The molecular diagnostic methods were used to evaluate 593 blood culture bottles from patients with bloodstream infections. The detection positivity of multiplex real-time PCR assay for Gram-positive bacteria, Gram-negative bacteria and Candida spp. was equivalent to PCR-REBA as 99.6 %, 99.1 % and 100 %, respectively. Using conventional bacterial cultures as the gold standard, the sensitivity, specificity, positive predictive value and negative predictive value of these two molecular methods were 99.5 % [95 % confidence interval (CI), 0.980-1.000; P<0.001), 100 % (95 % CI, 0.983-1.000; P<0.001), 100 % and 99 %, respectively. However, positivity of the Real-methicillin-resistant Staphylococcus aureus multiplex real-time PCR assay targeting the mecA gene to detect methicillin resistance was lower than that of the PCR-REBA method, detecting an overall positivity of 98.4 % (n=182; 95 % CI, 0.964-1.000; P<0.009) and 99.5 % (n=184; 95 % CI, 0.985-1.000; P<0.0001), respectively. The entire two methods take about 3 h, while results from culture can take up to 48-72 h. Therefore, the use of these two molecular methods was rapid and reliable for the characterization of causative pathogens in bloodstream infections.

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Prediction of Outcome from Community-Acquired Severe Sepsis and Septic Shock in Tertiary-Care University Hospital in a Developing Country

Cited by 24 publications

References 28 publications

Performance of the Verigene Gram-Positive Blood Culture Assay for Direct Detection of Gram-Positive Organisms and Resistance Markers in a Pediatric Hospital

Performance of the Verigene Gram-Positive Blood Culture Assay for Direct Detection of Gram-Positive Organisms and Resistance Markers in a Pediatric Hospital

CD64 index on neutrophils can diagnose sepsis and predict 30-day survival in subjects after ventilator-associated pneumonia

Comparison of multiplex real-time PCR and PCR-reverse blot hybridization assay for the direct and rapid detection of bacteria and antibiotic resistance determinants in positive culture bottles

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