Serum procalcitonin and C-reactive protein in the evaluation of bacterial infection in generalized pustular psoriasis

Wang, Siyu; Xie, Zhen; Shen, Zhu

doi:10.1016/j.abd.2019.09.022

Cited by 8 publications

(6 citation statements)

References 34 publications

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“…showed in the meta-analysis that the higher the severity in terms of clinical severity, the higher the number of patients who were given antibiotics (severe 100% vs. moderate 67.9%) [ 23 ]. Elevated inflammatory markers such as CRP and procalcitonin, together with leukocytosis and increased neutrophil count, were associated with higher antibiotic prescriptions [ 21 , 36 ]. This could be due to the cytokine release syndrome that produces signs and symptoms that may be difficult to distinguish from sepsis or septic shock due to bacterial infections.…”

Section: Discussionmentioning

confidence: 99%

The landscape of antibiotic usage among COVID-19 patients in the early phase of pandemic: a Malaysian national perspective

Mohamad

Wong

Chew

et al. 2022

J of Pharm Policy and Pract

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Background During the early phase of the COVID-19 pandemic, antibiotic usage among COVID-19 patients was noted to be high in many countries. The objective of this study was to determine the prevalence of antibiotic usage and factors affecting antibiotic usage among COVID-19 patients during the early phase of the COVID-19 pandemic in Malaysia. Methods This was a cross-sectional study that involved reviewing medical records of COVID-19 Malaysian patients aged 12 and above who were diagnosed with COVID-19 and received treatment in 18 COVID-19 hospitals from February to April 2020. A minimum sample of 375 patients was required. A binary logistic regression analysis was performed to determine factors associated with antibiotic usage. Variables with p < 0.05 were considered statistically significant. Results A total of 4043 cases were included for analysis. The majority of the patients (87.6%) were non-smokers, male (65.0%), and had at least one comorbidity (37.0%). The median age was 35 years (IQR: 38). The prevalence of antibiotic usage was 17.1%, with 5.5% of them being prescribed with two or more types of antibiotics. The most frequent antibiotics prescribed were amoxicillin/clavulanic acid (37.8%), ceftriaxone (12.3%), piperacillin/tazobactam (13.3%), azithromycin (8.3%), and meropenem (7.0%). Male patients (adjusted OR 1.53), who had a comorbidity (adjusted OR 1.36), associated with more severe stage of COVID-19 (adjusted OR 6.50–37.06), out-of-normal range inflammatory blood parameters for neutrophils, lymphocytes, and C-reactive protein (adjusted OR 2.04–3.93), corticosteroid use (adjusted OR 3.05), and ICU/HDU admission (adjusted OR 2.73) had higher odds of antibiotic use. Conclusions The prevalence of antibiotic usage in the early phase of the COVID-19 pandemic was low, with amoxicillin/clavulanic acid as the most common antibiotic of choice. The study showed that clinicians rationalized antibiotic usage based on clinical assessment, supported by relevant laboratory parameters.

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Section: Discussionmentioning

confidence: 99%

The landscape of antibiotic usage among COVID-19 patients in the early phase of pandemic: a Malaysian national perspective

Mohamad

Wong

Chew

et al. 2022

J of Pharm Policy and Pract

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“…A PCT of less than 1.50 along and/or a CRP of less than 46.75 can likely exclude a bacterial infection as the cause. 5 Our patient had a PCT of 7.35 and a CRP of 19.9. Though the PCT was suggestive of infection, we were comfortable with higher immunosuppression based on the CRP being well below the reported cut off value for infection and given all her infectious studies came back negative.…”

Section: Case Reportmentioning

confidence: 61%

“…Though the PCT was suggestive of infection, we were comfortable with higher immunosuppression based on the CRP being well below the reported cut off value for infection and given all her infectious studies came back negative. 5 We sought a rapid acting therapeutic with less immunosuppressive potential than traditional therapies, of which she had failed many in the past.…”

Section: Case Reportmentioning

confidence: 99%

Rapid Efficacy of Ixekizumab for Pediatric Acute Generalized Pustular Psoriasis

2021

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Introduction: Generalized pustular psoriasis (GPP) is a rare, severe variant of psoriasis that is uncommon in pediatric patients and can be refractory to many therapies. Ixekizumab, a monoclonal antibody that selectively inhibits interleukin 17-A, has been reported as safe and efficacious in patients with GPP, though minimal data exists on its use in the pediatric population. Case presentation: A 17-year-old female with history of alopecia areata and pustular psoriasis, on ustekinumab, was admitted for a severe pustular psoriasis flare with systemic symptoms including fever and tachycardia which progressed to erythroderma and required vasopressor support. After minimal improvement with 24 hours on broad-spectrum antibiotics, she received cyclosporine 5mg/kg/day. On day three of admission, and after two days of cyclosporine with minimal improvement, she received a 160 mg loading dose of ixekizumab. She defervesced and transferred out of the ICU within 24 hours. She was successfully weaned off cyclosporine after her second dose of ixekizumab. She experienced no adverse reactions. Discussion: Generalized pustular psoriasis is less common and often more severe than plaque psoriasis, associated with increased morbidity and mortality in both pediatric and adult patients. Clinical trials and case series have reported rapid and sustained improvement in patients with pustular psoriasis refractory to other therapies, though there is little data on the pediatric population. This case demonstrates the rapid efficacy of ixekizumab for severe erythrodermic pustular psoriasis in a pediatric patient, highlighting its use not only for refractory disease, but also as a rescue therapy in an emergent setting.

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“… 13 , 26 , 27 A sensitive indicator of bacterial pathogen infection, PCT had become an important inflammatory biomarker for identifying bacterial respiratory infections, bloodstream infections, and urinary system infections. 28 Serum PCT can rise rapidly and last for a long time in patients with bloodstream infection, which is valuable in the early diagnosis of bacterial infections. 29–31 In this study, AUCs of PCT for the postoperative infection were high on both POD1 and POD3.…”

Section: Discussionmentioning

confidence: 99%

Composite Inflammatory Indicators as Early Predictor of Intra-abdominal Infections after General Surgery

Song¹,

Lu²

2021

JIR

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Objective To identify rapid and accurate early diagnostic indicators for intra-abdominal infection (IAI) after general surgery. Methods We conducted a retrospective analysis of 3,810 general surgical patients in our hospital from August 2017 to July 2018. The predictive value of PCT, CRP, TNFα, and IL6 on postoperative days (PODs) 1 and 3 and composite indicators for complicated IAIs among surgical patients was clarified. Results There were 271 patients in the infected group and 614 patients in the uninfected group using IAI diagnostic criteria in this study. CRP, PCT, TNFα, and IL6 in the infected group were significantly higher than the uninfected group on POD1 and POD3. In the infected group, the composition of the four indicators on POD1 (AUC 0.819) and POD3 (AUC 0.848) showed higher predictive efficiency than the individual indicators (AUC 0.670–0.805). Conclusion The composite of CRP, PCT, TNFα, and IL6 can be used as a predictor of postoperative abdominal infectious complications with high sensitivity and specificity on POD1 and POD3, which can provide a basis for early diagnosis of postoperative abdominal infectious complications.

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Serum procalcitonin and C-reactive protein in the evaluation of bacterial infection in generalized pustular psoriasis

Cited by 8 publications

References 34 publications

The landscape of antibiotic usage among COVID-19 patients in the early phase of pandemic: a Malaysian national perspective

The landscape of antibiotic usage among COVID-19 patients in the early phase of pandemic: a Malaysian national perspective

Rapid Efficacy of Ixekizumab for Pediatric Acute Generalized Pustular Psoriasis

Composite Inflammatory Indicators as Early Predictor of Intra-abdominal Infections after General Surgery

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