Biomarcadores y sospecha de infección en los servicios de urgencias

Objectives. The aim of the study was to analyze predictive factors of bacteraemia in patients seen in the emergency department (ED) for an episode of infectious disease. Patients and methods. Observational, retrospective and descriptive analytical study of all blood cultures extracted in an ED in adult patients (≥ 18 years) seen in ED due to infectious disease from 1-1-2019 to 1-7-2019. The follow-up was carried out during 30 days. Thirty-eight variables for predicting bacteraemia were assessed. They covered epidemiological, comorbidity, functional, clinical and analytical factors. Univariate and multivariate logistic regression analysis was performed. Results. A total of 1,425 blood cultures were finally enrolled in the study. Of those were considered true bacteremia 179 (12.6 %) and as negative blood cultures 1,246 (87.4 %). Amongst negatives, 1,130 (79.3%) without growth and 116 (8.1%) as contaminants blood cultures. Five variables were significantly associated with true bacteraemia: serum procalcitonin (PCT)

Section: Discussionunclassified

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Predictive factors of bacteraemia in the patients seen in emergency departments due to infections

Iqbal‐Mirza¹,

Estévez-González²,

Ávila³

et al. 2020

“…La PCT en casos de sepsis grave/shock séptico presenta una mayor precisión que la PCR o que la leucocitosis. [8,[13][14][15][16]. Es posible que sea el biomarcador con mejor capacidad diagnostica y pronostica en la actualidad.…”

Section: Tablaunclassified

Utility of the blood culture in infection of the urinary tract with fever in the elderly

Artero¹,

Núñez²,

Bravo³

et al. 2021

Introduction. Urinary tract infections are one of the most common community infections. The diagnosis of urinary infections in the elderly is complex because of its presentation and clinic. The aim of this article is to evaluate the usefulness of blood cultures in febrile urinary tract infection in elderly patients, risk factors, causes of discordance between urine and blood cultures, usefulness of biomarkers and mortality. Material and methods. Observational study of patients admitted over 65 years old, with urinary infections. Results. A total of 216 episodes with urinary infections and blood cultures performed. 70 (32,4%) cases with bacteremia. The most frequently detected isolates in blood cultures were: Escherichia coli 50 (71,4%) and Proteus spp. 6 (8,5%). Only septic shock was associated with a higher frequency of bacteraemia (OR=2,93, IC 95: 1,0-8,5; p=0,04). In 26 of the blood cultures a different isolation of the urine culture was detected. Overall mortality was 9.1%, with no association with the presence of bacteremia (p>0. 05). Conclusions. One third of elderly people hospitalized by tract urinary infection had bacteremia. Their detection was not associated with overall mortality. Disagree between blood and urine cultures in febrile is frequent, especially in patients with recent antibiotic treatment or recently hospitalized.

“…Junto a estos factores mencionados y de forma muy significativa en los últimos tres años se ha validado la utilidad de los BMRII para predecir bacteriemia [35,36]. Entre ellos, por sus resultados y disponibilidad en los SUH españoles, destacan la proteína C reactiva (PCR), las interleucinas (IL) 6 y 8, el lactato, la proadrenomedulina (proADM), la presepsina, el dímero D y el receptor soluble del activador del plasminógeno de tipo uroquinasa (su-PAR) [35,36,[44][45][46][47][48][49][50][51]. Pero, entre todos los BMRII, la procalcitonina (PCT) obtiene el mejor rendimiento predictivo sobre el resto para predecir bacteriemia y a su vez poder orientar hacia el patógeno causante de la infección, su evolución clínica (a sepsis grave y shock séptico) y la mortalidad [2, 35,36,[52][53][54][55][56][57][58][59].…”

Section: Introductionunclassified

New predictive models of bacteremia in the emergency department: a step forward

Julián-Jiménez¹,

Rubio-Díaz²,

Castillo³

et al. 2022

The care of patients with a suspected infectious process in hospital emergency department (ED) has increased in the last decade to account for around 15-20% of all daily care. In the initial evaluation of these patients, samples are taken for the different microbiological studies in 45% of the cases, where obtaining blood cultures (BC) predominates, in 14.6% of all of them. The diagnostic yield of these BC is highly variable (2-20%). The most frequent suspected or confirmed foci or infectious processes of true bacteremia (TB) in the ED are urinary tract infection (45%) and respiratory infection (25%). For all these reasons, the suspicion and confirmation of TB has a relevant diagnostic and prognostic significance and requires changing some of the most important decisions to be made in the ED. Among others, indicate discharge or admission, extract BC and administer the appropriate and early antimicrobial. The intention of this review is to highlight the scientific evidence published in the last five years, clarify the current controversies and compare the ability to predict bacteremia of the latest predictive models published since 2017 with those already existing on that date, year in which a review was published that left open the proposal to continue searching for a model with adequate performance for ED. And so, based on it, generate different recommendations that help define the role that these models or scales can have in improving the indication for obtaining BC, as well as in the immediate making of other diagnostic-therapeutic decisions (administration early and appropriate antibiotic treatment, request for complementary tudies and other microbiological samples, intensity of hemodynamic support, need for admission, etc.)