Bloodstream infections are a major cause of morbidity and mortality worldwide. Molecular methods for the detection of pathogens in blood have been developed. The clinical utility of these methods and their integration into the clinical workflow is discussed.

CD64 index, CRP and sCD14-ST served as good parameters to determine possible infection in patients that needed intensive care after major procedures. Values of PCT were the only ones to predict SIRS severity and could distinguish between sepsis and severe sepsis or septic shock.

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.

P lacement of external ventricular drainage (EVD) and draining of the cerebrospinal fluid (CSF) when intracranial pressure (ICP) is elevated are frequently used for treating intracranial hypertension caused by a variety of neurological conditions. However, such an invasive procedure allows free entrance for bacteria and presents an increased risk of infection that can lead to meningitis, ventriculitis, or even death. The incidence of EVD-related ventriculitis ranges from 10% to 27% according to the literature (1-5). The most significant group of microorganisms causing ventriculitis is Staphylococcus spp., especially coagulase-negative staphylococci, followed by Staphylococcus aureus. Other Grampositive organisms, such as Streptococcus spp., Enterococcus spp., Corynebacterium spp., and Propionibacterium spp., may be involved. Most ventricular infections are a result of contamination during the insertion of the EVD (6, 7). In order to prevent this complication or to detect initiating steps of the disease, early diagnosis and treatment are crucial, yet little has been reported in the literature about its management. The CSF total cell count, differential count, and concentration of proteins and glucose are parameters providing early information pertaining to the diagnosis of bacterial CSF infection. However, cell counts are often unreliable because of blood contamination of the CSF caused by primary or secondary ventricular hemorrhage or by chemical reactions to the drain material. Blood laboratory markers are also frequently elevated because of concomitant bacterial infection (8). C-reactive protein (CRP) and procalcitonin (PCT) were tested for their use to predict infection, but the results were contradictory (8, 9). Bacteriological culture methods such as CSF cultures may take several days until bacterial growth can safely be excluded (9). Furthermore, many patients with EVD are on antibiotic therapy and isolation of bacteria from CSF is often difficult. Thus, there is a need for new markers with higher specificity for early detection of meningitis and ventriculitis. Brain macrophages play a pivotal role during inflammatory reactions of the central nervous system (CNS) parenchyma, ventricles, and meninges, and are involved in the release of soluble CD14 (sCD14) (10). In a study of 91 patients, serum sCD14 levels were measured, and the levels increased during acute bacterial meningitis. Increased CSF and serum sCD14 concentrations were also observed in meningitis caused by viral infection. Repeated measurement of sCD14 in CSF revealed a normalization of sCD14 levels during clinical recovery (10). Determination of presepsin (sCD14-ST) in CSF could overcome problems with time-consuming procedures while measuring sCD14. CD14 is a glycosylphosphatidylinositol (GPI)-anchored glycoprotein

The aim of this study was to evaluate the predictive value of factors in infertile male patients to retrieve sperm from their testicles before they undergo testicular sperm extraction (TESE). In total, 64 males were enrolled in this study. Infertility was identified as obstructive azoospermia (OA); non-obstructive azoospermia (NOA); Klinefelter syndrome (KS); and cryptozoospermia (Crypt). Age, body mass index and concomitant conditions were noted. Testicular volumes, serum levels of Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), testosterone (T) and prolactin were investigated. Sperm retrieval after TESE was noted as positive or negative. Average age of the cases was 36.8 years. TESE success rate of testicular sperm retrieval rate was 50.0%. Majority of men (83.9%) had a 46, XY karyotype, minority had genetic anomalies, and 5 of were diagnosed with KSall were TESE-negative. There was no statistical difference in age, testicular volume, presence of varicocele and microcalcifications or hormonal levels in the TESE-positive and negative groups. Smoking as an independent variable was the only risk factor statistically showing (OR = 0.269; p = 0.045) prediction of negative sperm retrieval after the TESE procedure. None of the parameters investigated herein predicted successful TESE outcomes. However, in cases with negative TESE only smoking was identified as a predictive factor for negative sperm retrieval and was established as a risk factor.