ДИНАМІКА ГОСТРОФАЗОВИХ ПОКАЗНИКІВ КРОВІ У ХВОРИХ НА НЕГОСПІТАЛЬНУ ПНЕВМОНІЮ, СПРИЧИНЕНУ SARS-COV-2

Introduction. A systemic inflammatory response to infection caused by SARS-CoV-2 is a hallmark of the coronavirus disease Covid-19, with abnormal inflammatory biomarkers in most patients. The aim of the study – to analyze changes in acute-phase indicators in patients with community-acquired pneumonia caused by SARS-CoV-2 and their dependence on the Charlson comorbidity index. Research Methods. A retrospective study of the medical records of 208 patients who were hospitalized for community-acquired pneumonia with a negative smear test for the SARS-CoV-2 virus was conducted. The main group consisted of patients with SARS-CoV-2 nucleic acid identification and signs of pneumonia. The severity of pneumonia was calculated according to the PORT scale. The comparison group consisted of patients with SARS-CoV-2 nucleic acid identification and the absence of pneumonia. The level of PSA, transferrin and procalcitonin in blood plasma was determined using an automatic analyzer ROCHE COBAS INTEGRA 400 plus. Results and Discussion. It was established that the levels of the investigated acute-phase blood parameters in patients with community-acquired pneumonia of all categories of complexity were probably higher than the control data. At the same time, the values ​​of PSA, procalcitonin, and ferritin in group II were probably lower than similar indicators in group III by 77.92 %, 58.93 %, and 83.11 %, respectively, in group IV by 157.76 %, 98.21 %, respectively. It is worth noting the highest values ​​of the investigated acute-phase indicators in patients with community-acquired pneumonia of the 4th category of complexity. Conclusions. Patients with community-acquired pneumonia caused by SARS-CoV-2 probably have higher values ​​of C-reactive protein, procalcitonin, and ferritin than controls, while the studied indicators probably increase with increasing pneumonia severity category.Вступ. Системна запальна відповідь на інфекцію, викликану SARS-CoV-2, є характерною ознакою коронавірусної хвороби (COVID-19) з аномальними біомаркерами запалення в більшості пацієнтів. Мета дослідження – проаналізувати зміни гострофазових показників крові у хворих на негоспітальну пневмонію, спричинену SARS-CoV-2, та їх залежність від індексу коморбідності Чарлсона. Методи дослідження. Було проведено ретроспективне дослідження медичних карт 208 пацієнтів, яких госпіталізували з приводу позалікарняної пневмонії з негативним результатом дослідження мазка на вірус SARS-CoV-2. Дослідні групи (2-гу, 3-тю, 4-ту) становили пацієнти з ідентифікацією нуклеїнової кислоти SARS-CoV-2 та ознаками пневмонії. Ступінь тяжкості пневмонії розраховували за шкалою PORT. До групи порівняння (1-ї) входили хворі з ідентифікацією нуклеїнової кислоти SARS-CoV-2 та без пневмонії. Рівні С-реактивного протеїну, трансферину та прокальцитоніну в плазмі крові визначали за допомогою автоматичного аналізатора “ROCHE COBAS INTEGRA 400 plus”. Результати й обговорення. Встановлено, що рівні досліджуваних гострофазових показників крові у пацієнтів з негоспітальною пневмонією всіх категорій складності вірогідно перевищували дані контролю. При цьому значення С-реактивного протеїну, прокальцитоніну та феритину в 2-й дослідній групі були достовірно нижчими від аналогічних показників у 3-й групі – на 77,92, 58,93 і 83,11 % відповідно, в 4-й – на 157,76, 98,21 та 159,15 %. Варто відмітити найвищі рівні досліджуваних гострофазових показників у пацієнтів з негоспітальною пневмонією 4-ї категорії складності. Висновок. У хворих на негоспітальну пневмонію, спричинену SARS-CoV-2, вірогідно вищі значення С-реактивного протеїну, прокальцитоніну та феритину стосовно контролю. При цьому досліджувані показники вірогідно зростають зі збільшенням категорії складності пневмонії

C reactive protein, Procalcitonin, Ferritin Levels in Mild, Severe and Critically Ill Patients with Coronavirus Disease 2019 (COVID-19)

The severe acute respiratory syndrome coronavirus-2 has infected millions of people worldwide, causing the COVID-19 pandemic. The pathogenic mechanism of infection is still under investigation.Due to lack of appropriate treatment, it is important to determine specific biomarkers to help clinicians identify patients at high risk of death, especially among those with severe COVID-19. These inflammatory factors may be prognostic biomarkers for predicting severe COVID-19 infection, therefore early identification of patients with COVID-19 with possible adverse prognostic factors is important for treatment and limiting severe outcomes and death.In the study we investigated the potential interdependence of some laboratory parameters - C reactive protein, procalcitonin, ferritin in different clinical severity COVID‐19 patients. Study results indicate that average values of these biomarkers vary in accordance with severity of COVID-19 infection. These values are explicitly higher in critically ill patients in comparison with mild and severe forms of disease

SENSITIVITAS DAN SPESIFISITAS PEMERIKSAAN PROKALSITONIN UNTUK MENDETEKSI KETERLIBATAN BAKTERI PADA PASIEN PNkUMONIA COVID-19 YANG DIRAWAT DI ICU RSUP DR M. DJAMIL PADANG

: Prokalsitonin merupakan salah satu marker yang dapat digunakan untuk melihat adanya infeksi bakteri. Pedoman tatalaksana pasien COVID-19 yang dikeluarkan oleh University of Michigan menganjurkan pemberian antibiotik padapasien COVID-19 dengan klinis infeksi bakteri sekunder yang memiliki kadar prokalsitonin >0,25 ng/ml. Penelitian ini bertujuan untuk melihat sensitivitas dan spesifisitas pemeriksaan prokalsitonin untuk mendeteksi keterlibatan bakteri pada pasien pneumonia COVID-19 yang dirawat di ICU RSUP DR M. Djamil Padang Metode: Penelitian ini merupakan penelitian analisis melalui pendekatan uji diagnostik dengan data yang bersumber dari data sekunder nilai PCT dan hasil kultur secret saluran napas pasien yang dirawat di ICU COVID-19 RSUP DR. M . Djamil Padang mulai 1 Desember 2021 sampai Mei 2022. Uji diagnostik menggunakan performance test dan analisis Receiver Operating Characteristic (ROC) Hasil: Karakteristik pasien sebagian besar adalah laki-laki (52,3%), usia 60-69 tahun (33,1%), memiliki 1 komorbid (40,4%), dan jenis komorbid terbanyak yaitu diabetes melitus (49,7%). Penelitian ini mendapatkan peningkatan yang dominan pada kadar Ddimer, ferritin, CRP, Interleukin 6. Pemeriksaan kultur sputum didapatkan tumbuh kuman banal dan peningkatan nilai prokalsitonin pada lebih dari setengah sampel. Nilai titik potong PCT didapatkan ≥0,4750 pada AUC 0,569 (0,474 - 0,663). Sensitivitas dan spesifisitas prokalsitonin yaitu 53,90% dan 53,20% Simpulan: Prokalsitonin sebagai marker infeksi pada COVID-19 klinis kritis digunakan dengan pertimbangan yang bai

Lung ultrasound may support internal medicine physicians in predicting the diagnosis, bacterial etiology and favorable outcome of community-acquired pneumonia

To assess the usefulness of lung ultrasound (LUS) for identifying community-acquired pneumonia (CAP) among adult patients with suspected lower respiratory tract infection (LRTI) and for discriminating between CAP with different cultural statuses, etiologies, and outcomes. LUS was performed at internal medicine ward admission. The performance of chest X-ray (CXR) and LUS in diagnosing CAP in 410 patients with suspected LRTI was determined. All possible positive results for pneumonia on LUS were condensed into pattern 1 (consolidation + / - alveolar-interstitial syndrome) and pattern 2 (alveolar-interstitial syndrome). The performance of LUS in predicting culture-positive status, bacterial etiology, and adverse outcomes of CAP was assessed in 315 patients. The area under the receiver operating characteristic curve for diagnosing CAP by LUS was significantly higher than for diagnosis CAP by CXR (0.93 and 0.71, respectively; p < 0.001). Pattern 1 predicted CAP with bacterial and mixed bacterial and viral etiologies with positive predictive values of 99% (95% CI, 94-100%) and 97% (95% CI, 81-99%), respectively. Pattern 2 ruled out mortality with a negative predictive value of 95% (95% CI, 86-98%), respectively. In this study, LUS was useful in predicting a diagnosis of CAP, the bacterial etiology of CAP, and favorable outcome in patients with CAP

Clinical Predictors of Bacteremia Outcome After Initial Empirical Antimicrobial Therapy in Patients with Hematological Malignancies: A Retrospective Analysis

Jinjie Gao,1 Jiajia Zheng,2 Hua Zhang,3 Jijun Wang,1 Hongmei Jing1 1Department of Hematology, Lymphoma Research Center, Peking University Third Hospital, Beijing, 100191, People’s Republic of China; 2Department of Laboratory Medicine, Peking University Third Hospital, Beijing, 100191, People’s Republic of China; 3Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, People’s Republic of ChinaCorrespondence: Hongmei Jing, Tel +86-010-82266785, Email [email protected]: We performed a retrospective analysis to investigate the clinical predictors of bacteremia outcome involving Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) after initial empirical antimicrobial therapy among hematological malignancy cases.Methods: This retrospective study was conducted between April 2018 and April 2023. All bloodstream infections (BSIs) caused by E. coli and K. pneumoniae in hospitalized hematological malignancy (HM) patients were identified. Data on patient demographics, clinical characteristics, empirical antimicrobial treatment, outcomes and the antimicrobial susceptibility were collected from medical records. Multivariate analyses were utilized to assess the risk factors for all-cause mortality within 28 days and carbapenem resistance. Optimal cutoffs for continuous predictive variables were evaluated by receiver operating characteristic (ROC) curve analysis.Results: Among 61 individuals diagnosed with bacteremia, 39 cases were caused by E. coli bacteremia, while the remaining 22 were identified as K. pneumoniae bacteremia. Out of these, there were 10 cases of carbapenem-resistant Enterobacteriaceae (CRE) and 12 cases resulted in all-cause mortality within 28 days. Analysis indicated that Pitt score was an independent risk factor for mortality and a cut-off of 2.5 was a reliable predictor with 83.3% sensitivity and 85.7% specificity, respectively. Impaired mental status and elevated body temperature exceeding 38.6°C as well as a procalcitonin (PCT) level over 8.24 ng/mL on the third day (d3) after antimicrobial treatment were identified as independent risk factors for predicting carbapenem resistance.Conclusion: We found that Pitt score with a cut-off of 2.5 was a reliable predictor for mortality within 28 days in HM bacteremia cases. Impaired mental status and elevated temperature exceeding 38.6°C as well as a procalcitonin (PCT) level over 8.24 ng/mL on d3 after antimicrobial treatment were identified as predictive risk factors to carbapenem resistance.Keywords: antimicrobial resistance, mortality, risk factors, initial clinical respons

Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients

PurposeAlthough the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia.MethodsWe carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations.ResultsBetween 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51-0.61) and 0.6 (95% CI, 0.55-0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5-98.5) and 98.2% (95% CI 97.5-98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25-3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT & GE; 0.12 ng/mL was associated with higher 90 days mortality.ConclusionOur study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19

Procalcitonin increase is associated with the development of critical care-acquired infections in COVID-19 ARDS

Secondary bacterial infection in COVID-19 patients is associated with increased mortality and disproportionately affects critically ill patients. This single-centre retrospective observational study investigates the comparative efficacy of change in procalcitonin (PCT) and other commonly available biomarkers in revealing or predicting microbiologically proven secondary infection in critical COVID-19 patients. Adult patients admitted to an intensive care unit (ICU) with confirmed SARS-CoV-2 infection between 9 March 2020 and 5 June 2020 were recruited to the study. For daily biomarker and secondary infection, laboratory-confirmed bloodstream infection (LCBI) and ventilator-associated pneumonia/tracheobronchitis (VAP/VAT) data were collected. We observed a PCT rise in 53 (81.5%) of the patients, a C-reactive protein (CRP) rise in 55 (84.6%) and a white blood cell count (WBC) rise in 61 (93.8%). Secondary infection was confirmed in 33 (50.8%) of the patients. A PCT rise was present in 97.0% of patients with at least one confirmed VAP/VAT and/or LCBI event. CRP and WBC rises occurred in 93.9% and 97.0% of patients with confirmed VAP/VAT and/or LCBI, respectively. Logistic regression analysis found that, when including all biomarkers in the same model, there was a significant association between PCT rise and the occurrence of LCBI and/or VAP/VAT (OR = 14.86 95%CI: 2.20, 342.53; p = 0.021). Conversely, no statistically significant relationship was found between either a CRP rise (p = 0.167) or a WBC rise (p = 0.855) and the occurrence of VAP/VAT and/or LCBI. These findings provide a promising insight into the usefulness of PCT measurement in predicting the emergence of secondary bacterial infection in ICU

Disinfection of Water Systems in Accordance with Eu Directives on Health and Safety in Working Environments: Use of A Technologically Advanced ClO2 Generator

One of the main problems in the management of water in buildings is the risk of legionnaires' disease for users and workers..

Initial Inflammatory Profile in Community-acquired Pneumonia Depends on Time since Onset of Symptoms

Rationale: Assessment of the inflammatory response can help the decision-making process when diagnosing community-acquired pneumonia (CAP), but there is a lack of information about the influence of time since onset of symptoms. Objectives: We studied the impact of the number of days since onset of symptoms on inflammatory cytokines and biomarker concentrations at CAP diagnosis in hospitalized patients. Methods: We performed a secondary analysis in two prospective cohorts including 541 patients in the derivation cohort and 422 in the validation cohort. The time since onset of symptoms was self-reported, and patients were classified as early presenters (<3 d) and nonearly presenters. Biomarkers (C-reactive protein [CRP] and procalcitonin [PCT] in both cohorts) and cytokines in the derivation cohort (IL-1, - 6, -8, -10, and tumor necrosis factor-α) were measured within 24 hours of hospital admission. Measurements and Main Results: In early presenters, CRP was significantly lower, whereas PCT, IL-6, and IL-8 were higher. Nonearly presenters showed significantly lower PCT, IL-6, and IL-8 levels. In the validation cohort, CRP and PCT exhibited identical patterns: CRP levels were 36.4% greater in patients with 3 or more days since onset of symptoms than in those with less than 3 days since symptom onset in the derivation cohort and 38.2% in the validation cohort. PCT levels were 40% lower in patients with 3 or more days since onset of symptoms in the derivation cohort and 56% in the validation cohort. Conclusions: Time since symptom onset modifies the systemic inflammatory profile at CAP diagnosis. This information has relevant clinical implications for management, and it should be taken into account in the design of future clinical trials

Pneumonia comunitária e hospitalar em box de emergência de um hospital público do distrito federal: estudo de prevalência, métodos diagnósticos, fatores de risco, tratamento e mortalidade

A pneumonia (PNM) é uma das doenças infectocontagiosas com a quarta maior taxa de morbimortalidade do país, sendo esta taxa ainda maior em pacientes imunodeprimidos, crianças e idosos. Entre janeiro de 2018 e janeiro de 2019, essa infecção pulmonar representou nacionalmente cerca de 53,11% das internações e 60,7% dos óbitos referentes a patologias do sistema respiratório. As PNMs são consideradas grandes desafios no controle de dados referentes à morbimortalidade e, principalmente, nos dispendiosos valores gastos. Isso ocorre devido certa escassez de dados e estudos epidemiológicos com informações conclusivas sobre a incidência, mortalidade e possíveis fatores relacionados ao prognóstico dessa patologia. Objetivo: investigar o perfil epidemiológico, métodos de diagnóstico, fatores de gravidade, morbimortalidade e tratamento, à partir da análise de prontuários, dos pacientes com diagnóstico de Pneumonia Nosocomial e Comunitária no Box de Emergência do Hospital Regional da Asa Norte (HRAN). Metodologia: É um estudo retrospectivo e prospectiva transversal, descritiva, com revisão de prontuários de pacientes internados no Box de Emergência do Hospital Regional da Asa Norte (HRAN) da Secretaria de Estado de Saúde do Distrito Federal, no período de janeiro/2018 a setembro/2019. Resultados: No período de janeiro/2018 a setembro/2019, foram analisados 592 prontuários e incluídos nesta análise 80 pacientes, segundo critérios de participação. 55% eram do sexo feminino, com média de idade foi de 70,48 ± 16,64. Quanto ao tipo de pneumonia, 54,5% pacientes possuíam o acometimento comunitário enquanto 47,5% o nosocomial. Em relação a comorbidades, foi visto que 91,25% dos pacientes possuíam comorbidades, sendo que cerca de 71,2% apresentavam pelo menos duas delas. As principais patologias listadas foram hipertensão arterial sistêmica, diabetes mellitus tipo 2, doença pulmonar obstrutiva crônica e insuficiência cardíaca. O escore CURB-65 da admissão, mostrou que 61,90% (N=26) atingiram score maior ou igual a três, que indica mortalidade alta. Para o acometimento comunitário, os antibióticos mais utilizados foram Meropenem, Piperacilina com Tazosulbactam, Cefepime e Ampicilina com Sulbactam,. No acometi enquanto no hospitalar, foram Meropenem, Ampicilina com Sulbactam, Vancomicina e Cefepime. A mortalidade geral do estudo foi de 86,25% (N=69), sendo especificamente para PAC de 85,61% (N=36) e 86,84% (N=33) para PH. Considerações finais: A pneumonia bacteriana, em sua forma comunitária e hospitalar, é considerado um acometimento importante no Box de Emergência, visto sua incidência e sua alta taxa de mortalidade. É importante ressaltar que idade avançada, a presença de comorbidades e associação ao hábito do tabagismo 4 são considerados fatores importantes de gravidade e que estão relacionados com a alta taxa de mortalidade. A PH determinou-se como uma complicação importante em pacientes da instituição, levando ao maior período de internação e maior demanda por suporte invasivo e maior número de antibióticos. O score CUBR-65 comportou-se como um preditor importante de gravidade e de mortalidade. O alto número de amostras de cultura sem resultados mostra-se como uma limitação importante para a constituição do perfil etiológico da instituiçã