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Respiratory Diseases
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Aref T. Senno, Ryan K. Brannon
Blood culture is positive in 5–11% of cases; positive blood cultures are more common in those with severe CAP [51]. Blood cultures should ideally be obtained before antibiotic administration. Procalcitonin has been proposed as a method to distinguish bacterial and viral infections. While higher procalcitonin levels have been associated with bacterial infections, there has not be a level determined to adequately rule out bacterial pneumonia, and thus should not be used to guide antibiotic administration [52].
Treatment of Ventilator-Associated Pneumonia
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
One of the most important advancements in VAP treatment in recent years has been the systematic shortening of treatment durations. Guided by results from several randomized controlled trials, patients receiving shorter courses of VAP therapy have demonstrated fewer days of antibiotic therapy as well as reductions in recurrent pneumonias due to multidrug resistant organisms without adverse effects on mortality. Less drug resistance and fewer antibiotic-related complications are the obvious advantages of shorter treatment courses, but some patients may remain undertreated with the currently recommended seven days of therapy. Serum procalcitonin has been used as a biomarker to guide the discontinuation of therapy, and may be particularly useful in patients who remain clinically unwell at the end of their treatment course. Use of procalcitonin in conjunction with clinical criteria to guide antibiotic discontinuation is currently recommended. This is particularly important considering the nearly 30% failure rate of initial treatment reported by Chastre et al. In their landmark study. Deciding who to treat, and for how long is certainly one of the great challenges in VAP management. The available evidence suggests we have erred on the side of overtreatment. Identifying ways to limit antibiotic therapy and detect treatment failure early will be instrumental to ensuring we have effective drugs for our future patients [5].
Severe Influenza Pneumonia and Its Mimics in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
The measurement of non-specific inflammation markers, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin, and fibrinogen may assist in excluding a bacterial coinfection from primary influenza A pneumonia. The CRP and ESR concentrations in serum usually peak during days 2–4 and 4–5 after influenza illness, respectively. Concentrations of procalcitonin greater than 0.5 μg/L support bacterial infection, whereas repeatedly low amounts suggest that bacterial infection is unlikely [32]. Fibrinogen concentrations are mostly low to normal. Measurement of serum ferritin may strongly assist as a diagnostic eliminator toward influenza A and suggests the possibility of an alternate diagnosis (high elevated ferritin levels are identified in Legionella infection) [33].
Risk factors of intensive care admission and mortality in a cohort of 111 Egyptian COVID-19 patients
Published in Egyptian Journal of Anaesthesia, 2022
Enas R Mohamed, Dina Ragab, Mohamed Taeimah, Heba Shaltoot
Procalcitonin is generally synthesized by parafollicular thyroid cells and is mainly induced by endotoxins; therefore, it is considered as a marker of sepsis in clinical practice. Endotoxins indirectly induce the production of procalcitonin by inducing the production of inflammatory cytokines [35]. However, these inflammatory cytokines are reported to be increased during COVID-19 infection, resulting in a cytokine storm. Thus, elevated levels of procalcitonin in COVID-19 might directly result from the cytokine storm that can occur during COVID-19 or could be due to a secondary bacterial infection [36]. In the present study, procalcitonin positivity was significantly higher among the non-survivors and in patients admitted to the ICU. Zhao et al. [19] also reported higher procalcitonin levels in non-survivors and in patients admitted to ICU. Moreover, Wang et al. [12] reported higher proportion of patients with positive procalcitonin among ICU patients compared to ward patients. Furthermore, Zhou et al. [14] and Ayed et al. [33] reported higher procalcitonin levels in non-survivors with a procalcitonin level of >0.2 ng/mL being an independent predictor of mortality.
Interferon-α2b induced anemia in severe coronavirus disease 2019 patients: a single centered, retrospective study
Published in Immunopharmacology and Immunotoxicology, 2021
Xina Li, Tong Liu, Xin Hai, Le Li
Seven patients had decreased white blood cell count on admission. Overall, lymphopenia was observed in 72.0% of patients. Thrombocytopenia was observed in 3 patients. 43 (86%) patients had increased D-dimer level and 35 (70%) patients had elevated levels of C-reactive protein. 13 patients and 17 patients had abnormal liver function with increased alanine aminotransferase and aspartate aminotransferase respectively. Most patients (88.0%) had normal serum levels of procalcitonin on admission. Increased lactate dehydrogenase was found in 29 (58%) patients (Table 2). No significant difference was found in laboratory findings between the two groups. Fifty patients were treated with an antiviral regimen on admission. In terms of supportive treatment, all of the patients received administration of intravenous antibiotics and thymosin. A total of 10% of patients received assisted mechanical ventilators. High flow oxygen therapy was given to 3 patients, and low flow oxygen therapy for 33 (60%) patients. The number of patients who received antifungal medications, systemic corticosteroids, and intravenous immunoglobin was 24, 32, and 36. Moreover, continuous renal replacement therapy was applied in 8 patients, and 38 patients received anticoagulation (Table 2).
Global personalization of antibiotic therapy in critically ill patients
Published in Expert Review of Precision Medicine and Drug Development, 2021
Dagan O Lonsdale, Jeffrey Lipman
Procalcitonin is again perhaps the most widely studied biomarker for the diagnosis of infection. One meta-analysis of 30 studies found a sensitivity of 0.77 and specificity of 0.79, with the area under receiver-operator-curve of 0.85 [85]. A recent consensus guide concluded that procalcitonin should be used for the diagnosis of infection. However, their conclusion that likelihood of bacterial infection and illness severity should be incorporated into algorithms suggests procalcitonin remains imperfect as a standalone biomarker [86]. Like other single biomarkers such as CRP, procalcitonin is raised in numerous other conditions, including burns, trauma, surgery, and thyroid carcinoma. The answer may lie in the use of biomarker arrays, where multiple molecules are screened and algorithms used to identify infection [87]. A number of proprietary technologies are in development to this end [88]. Rapid identification of bacterial pathogens would also assist clinicians. Evidence from clinical studies is encouraging. Combined polymerase-chain reaction-mass spectrometry analysis of specimens provides a rapid identification of bacterial pathogens (within 6 h). However, the technique remains imperfect with one in five cases missed in one international study [89], although ongoing development of the technology may improve these results [90].