Biomarkers to delineate bacteremia from candidemia remain a challenging issue

Honoré, Patrick M.; David, Cristina; Attou, Rachid; Redant, Sébastien; Gallerani, Andrea; Bels, David De

doi:10.1186/s13054-019-2720-2

Cited by 5 publications

(5 citation statements)

References 9 publications

(16 reference statements)

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“…Furthermore, prone ventilation in patients on vv-ECMO could be done without problems. These findings are consistent with findings reported elsewhere [ 11–13 ]. During the vv-ECMO runs, several complications were noted.…”

Section: Discussionsupporting

confidence: 94%

“…This finding is in accordance with the reports in the literature on cytokine expression during sCOVID-19-induced ARDS. Previous data confirmed worse outcomes in patients with elevated interleukin 6 concentrations [ 19 , 20 ]. After being weaned from vv-ECMO, all patients were transferred to a respiratory weaning centre for further recovery.…”

Section: Discussionmentioning

confidence: 58%

“…To date, there is no adequate curative option for patients with severe respiratory impairment. Thus, guidelines for the management of moderate-to-severe respiratory impairment due to COVID-19 infection have been proposed [ 11 ]. These guidelines recommend the use of vv-ECMO in patients in whom conservative therapeutic options have failed.…”

Section: Discussionmentioning

confidence: 99%

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Mechanical circulatory support in coronavirus disease-2019-positive patients with severe respiratory failure

Natanov

Wiesner

Haverich

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Treatment of severe acute respiratory distress syndrome (ARDS) induced by severe acute respiratory syndrome coronavirus 2 has been heavily debated. Our goal was to describe our findings in patients with severe ARDS due to severe coronavirus disease 2019 (sCOVID-19) treated with venovenous extracorporeal membrane oxygenation (vv-ECMO). METHODS We retrospectively examined all patients treated with vv-ECMO for severe ARDS due to acute respiratory syndrome coronavirus 2. RESULTS In total, 13 patients were treated with vv-ECMO in our medical centre. The mean patient age was 48.1 years. Most patients were obese (69%) and male (85%). All patients were mechanically ventilated before ECMO. The mean time from intubation to proning was 16.6 h; the time from start of prone therapy to vv-ECMO implantation was 155.1 h. The mean total ECMO run time was 358 h. Significant reduction of positive end-expiratory pressure (P = 0.02), peak pressure (P = 0.001) and minute volume (P = 0.03) could be achieved after implantation of vv-ECMO. All patients showed an inflammatory response. Overall mortality was 30.7%: 1 patient died of mesenteric ischaemia; 3 patients died of multiple organ failure. A worse prognosis was seen in patients with highly elevated concentrations of interleukin-6. CONCLUSIONS The use of vv-ECMO in patients with sCOVID-19-induced ARDS is safe and associated with improved respiratory ventilation settings. The rate of immune system involvement plays a pivotal role in the development and outcome of sCOVID-19.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 58%

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Mechanical circulatory support in coronavirus disease-2019-positive patients with severe respiratory failure

Natanov

Wiesner

Haverich

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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“…PCT is a biomarker for infections and can also serve as a promising prognostic indicator in patients with Candida and bacterial infections. Some studies have attempted to differentiate between candidemia and bacteraemia based on PCT levels; however, the differentiation remains challenging ( Cortegiani et al, 2019 ; Honore et al, 2020 ). Besides, the lymphocyte count was a prognostic indicator of infection and was associated with mortality ( Hatinguais, Willment & Brown, 2020 ; Zhang et al, 2020a ).…”

Section: Discussionmentioning

confidence: 99%

Machine-learning based prediction and analysis of prognostic risk factors in patients with candidemia and bacteraemia: a 5-year analysis

Gao

Tang

et al. 2022

PeerJ

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Bacteraemia has attracted great attention owing to its serious outcomes, including deterioration of the primary disease, infection, severe sepsis, overwhelming septic shock or even death. Candidemia, secondary to bacteraemia, is frequently seen in hospitalised patients, especially in those with weak immune systems, and may lead to lethal outcomes and a poor prognosis. Moreover, higher morbidity and mortality associated with candidemia. Owing to the complexity of patient conditions, the occurrence of candidemia is increasing. Candidemia-related studies are relatively challenging. Because candidemia is associated with increasing mortality related to invasive infection of organs, its pathogenesis warrants further investigation. We collected the relevant clinical data of 367 patients with concomitant candidemia and bacteraemia in the first hospital of China Medical University from January 2013 to January 2018. We analysed the available information and attempted to obtain the undisclosed information. Subsequently, we used machine learning to screen for regulators such as prognostic factors related to death. Of the 367 patients, 231 (62.9%) were men, and the median age of all patients was 61 years old (range, 52–71 years), with 133 (36.2%) patients aged >65 years. In addition, 249 patients had hypoproteinaemia, and 169 patients were admitted to the intensive care unit (ICU) during hospitalisation. The most common fungi and bacteria associated with tumour development and Candida infection were Candida parapsilosis and Acinetobacter baumannii, respectively. We used machine learning to screen for death-related prognostic factors in patients with candidemia and bacteraemia mainly based on integrated information. The results showed that serum creatinine level, endotoxic shock, length of stay in ICU, age, leukocyte count, total parenteral nutrition, total bilirubin level, length of stay in the hospital, PCT level and lymphocyte count were identified as the main prognostic factors. These findings will greatly help clinicians treat patients with candidemia and bacteraemia.

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“…84 Concerns exist, however, about the usage of this biomarker in critically ill patients who often have kidney injury requiring hemodialysis, which may affect procalcitonin levels. 85,86 Risk Prediction Tools Several prediction tools were developed and validated to prevent delayed diagnosis. The Candida Score, the Candida Colonization Index (CCI), the Corrected Candida Colonization Index, and the Ostrosky Clinical Prediction Rule (CPR) are discussed later.…”

Section: Procalcitoninmentioning

confidence: 99%

Diagnosis and Management of Invasive Candida Infections in Critically Ill Patients

Zakhem

Istambouli

Jabbour

et al. 2022

Semin Respir Crit Care Med

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Invasive candidiasis (IC) has become a serious problem in the intensive care unit patients with an attributable mortality rate that can reach up to 51%. Multiple global surveillance studies have shown an increasing incidence of candidemia. Despite their limited sensitivity (21–71%), cultures remain the gold standard for the diagnosis of IC associated with candidemia. Many adjunct laboratory tests exist to support or rule out the diagnosis, each with its indications and limitations, including procalcitonin, 1,3-β-D-glucan, mannan and anti-mannan antibodies, and Candida albicans germ tube antibody. In addition, polymerase chain reaction-based methods could expedite species identification in positive blood cultures, helping in guiding early empirical antifungal therapy. The management of IC in critically ill patients can be classified into prophylactic, preemptive, empiric, and directed/targeted therapy of a documented infection. There is no consensus concerning the benefit of prophylactic therapy in critically ill patients. While early initiation of appropriate therapy in confirmed IC is an important determinant of survival, the selection of candidates and drug of choice for empirical systemic antifungal therapy is more controversial. The choice of antifungal agents is determined by many factors, including the host, the site of infection, the species of the isolated Candida, and its susceptibility profile. Echinocandins are considered initial first-line therapy agents. Due to the conflicting results of the various studies on the benefit of preemptive therapy for critically ill patients and the lack of robust evidence, the Infectious Diseases Society of America (IDSA) omitted this category from its updated guidelines and the European Society of Intensive Care Medicine (ESICM) and the Critically Ill Patients Study Group of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) do not recommend it.

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Biomarkers to delineate bacteremia from candidemia remain a challenging issue

Cited by 5 publications

References 9 publications

Mechanical circulatory support in coronavirus disease-2019-positive patients with severe respiratory failure

Mechanical circulatory support in coronavirus disease-2019-positive patients with severe respiratory failure

Machine-learning based prediction and analysis of prognostic risk factors in patients with candidemia and bacteraemia: a 5-year analysis

Diagnosis and Management of Invasive Candida Infections in Critically Ill Patients

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