Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients

Carbonell, Raquel; Urgelés, Silvia; Salgado, Melina; Rodríguez, Alejandro; Reyes, Luis Felipe; Fuentes, Yuli V.; Serrano, Cristian C; Cáceres, Eder; Bodí, M.; Martín‐Loeches, Ignacio; Solé‐Violán, Jordi; Dı́az, Emili; Gómez, Josep; Trefler, Sandra; Vallverdú, Montserrat; Murcia, J.B.; Albaya, Antonio; Loza, Ana; Socías, Lorenzo; Ballesteros, Juan; Papiol, Elisabeth; Viña, L.; Sancho, Susana; Nieto, M.; Del, M; Lorente, Carmen; Badallo, Oihane; Fraile, Virginia; Arméstar, Fernándo; Estella, Ángel; Abanses, Paula; Sancho, Isabel; Guasch, Neus; Moreno, Gerard

doi:10.1016/j.jinf.2022.06.024

Cited by 25 publications

(21 citation statements)

References 55 publications

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“…Elevated levels of PCT were observed in most patients with bacterial co-infections in our cohort. As the patients recovered, their PCT levels returned to normal, aligning with ndings from other studies highlighting the predictive role of PCT in bacterial coinfection among severe and critical COVID-19 patients [17][18][19], although the exact association between PCT levels and co-infections or mortality in COVID-19 is not fully elucidated.…”

Section: Discussionsupporting

confidence: 83%

Critically ill children with SARS-COV-2 Omicron infection at a national children medical center, Guangdong, China

Lin,

Jiang,

Zhang

et al. 2023

Preprint

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Background SARS-CoV-2 infection is described as asymptomatic, mild, or moderate disease in most children. SARS-CoV-2 related death in children and adolescents is rare according to the current reports. COVID-19 cases increased significantly in China during the Omicron surge, clinical data regarding pediatric critical patients infected with the omicron variant is limited. In this study, we aim to provide an overview of the clinical characteristics and outcomes of children admitted to the Pediatric Intensive Care Unit (PICU) at a national children's medical center in Guangdong Province, China, during the outbreak of the omicron variant infection. Methods We conducted a retrospective study from November 25, 2022, to February 8, 2023, which included 63 critically ill children, under the age of 18, diagnosed with SARS-CoV-2 infection. The patients were referred from medical institutions of Guangdong province. The medical records of these patients were carefully analyzed and summarized. Results During the study period, 63 children were included. The median age was 2 years (IQR: 1.0–8.0), sex-ratio (male/female) was 1.52. Twelve patients (age ≥ 3 years) were vaccinated. The median length of hospital stay was 14 days (IQR: 6.5–23) and duration of fever was 5 days (IQR: 3-8.5). 30 cases had clear contact history with family members who were infected with SARS-CoV-2. Three children who tested positive for COVID-19 infection did not show any abnormalities on chest imaging examination. Out of the total patients, 33 had a bacterial co-infection, with Staphylococcus aureus being the most commonly detected bacterial pathogen. Our cohort exhibited respiratory and nervous system involvement as the primary features. Furthermore, 50 patients required mechanical ventilation, with a median duration of 7 days (IQR 3.75–13.0). Among these patients, 35 developed respiratory failure, 16 patients experienced a deteriorating progression of symptoms and ultimately succumbed to the illness, with multiple organ failure being the attributed cause of death. Conclusion We present a case series of critically ill children infected with the SARS-CoV-2 omicron variant. While there is evidence suggesting that Omicron may cause less severe symptoms, it is important to continue striving for measures that can minimize the pathogenic impact of COVID-19 infection in children.

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Section: Discussionsupporting

confidence: 83%

Critically ill children with SARS-COV-2 Omicron infection at a national children medical center, Guangdong, China

Lin,

Jiang,

Zhang

et al. 2023

Preprint

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“…We observed that coinfection was more prevalent in patients with HAP than in those with CAP. Previous research has indicated that coinfection is significantly associated with disease severity and high mortality [ 26 ]. A study from Korea reported that 13.6% of patients with CAP had coinfection, while the proportion increased to 21.9% in patients with severe CAP [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation and clinical practice of pathogens and antimicrobial resistance genes of BioFire FilmArray Pneumonia panel in lower respiratory tract infections

Gong,

Yang,

Liu

et al. 2023

Infection

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Background Existing panels for lower respiratory tract infections (LRTIs) are slow and lack quantification of important pathogens and antimicrobial resistance, which are not solely responsible for their complex etiology and antibiotic resistance. BioFire FilmArray Pneumonia (PN) panels may provide rapid information on their etiology. Methods The bronchoalveolar lavage fluid of 187 patients with LRTIs was simultaneously analyzed using a PN panel and cultivation, and the impact of the PN panel on clinical practice was assessed. The primary endpoint was to compare the consistency between the PN panel and conventional microbiology in terms of etiology and drug resistance, as well as to explore the clinical significance of the PN panel. The secondary endpoint was pathogen detection using the PN panel in patients with community-acquired pneumonia (CAP) or hospital-acquired pneumonia (HAP). Results Fifty-seven patients with HAP and 130 with CAP were included. The most common pathogens of HAP were Acinetobacter baumannii and Klebsiella pneumoniae, with the most prevalent antimicrobial resistance (AMR) genes being CTX-M and KPC. For CAP, the most common pathogens were Haemophilus influenzae and Staphylococcus aureus, with the most frequent AMR genes being CTX-M and VIM. Compared with routine bacterial culture, the PN panel demonstrated an 85% combined positive percent agreement (PPA) and 92% negative percent agreement (NPA) for the qualitative identification of 13 bacterial targets. PN detection of bacteria with higher levels of semi-quantitative bacteria was associated with more positive bacterial cultures. Positive concordance between phenotypic resistance and the presence of corresponding AMR determinants was 85%, with 90% positive agreement between CTX-M-type extended-spectrum beta-lactamase gene type and phenotype and 100% agreement for mecA/C and MREJ. The clinical benefit of the PN panel increased by 25.97% compared with traditional cultural tests. Conclusion The bacterial pathogens and AMR identified by the PN panel were in good agreement with conventional cultivation, and the clinical benefit of the PN panel increased by 25.97% compared with traditional detection. Therefore, the PN panel is recommended for patients with CAP or HAP who require prompt pathogen diagnosis and resistance identification.

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“…Since S100A12 activation may last for several months in certain patients with COVID-19, it warrants further investigation whether this sustained activation is associated with some of the lingering symptoms in long COVID [ 65 ]. In addition, another application is to rule out secondary bacterial co-infection when S100A12 activation is not detected, similar to the recently proposed usage of PCT [ 66 ]. This is because S100A12 activation is the most prominent signature of bacterial infection (with or without viral co-infection).…”

Section: Discussionmentioning

confidence: 99%

A two-gene marker for the two-tiered innate immune response in COVID-19 patients

Lei

2023

PLoS ONE

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For coronavirus disease 2019 (COVID-19), a pandemic disease characterized by strong immune dysregulation in severe patients, convenient and efficient monitoring of the host immune response is critical. Human hosts respond to viral and bacterial infections in different ways, the former is characterized by the activation of interferon stimulated genes (ISGs) such as IFI27, while the latter is characterized by the activation of anti-bacterial associated genes (ABGs) such as S100A12. This two-tiered innate immune response has not been examined in COVID-19. In this study, the activation patterns of this two-tiered innate immune response represented by IFI27 and S100A12 were explored based on 1421 samples from 17 transcriptome datasets derived from the blood of COVID-19 patients and relevant controls. It was found that IFI27 activation occurred in most of the symptomatic patients and displayed no correlation with disease severity, while S100A12 activation was more restricted to patients under severe and critical conditions with a stepwise activation pattern. In addition, most of the S100A12 activation was accompanied by IFI27 activation. Furthermore, the activation of IFI27 was most pronounced within the first week of symptom onset, but generally waned after 2–3 weeks. On the other hand, the activation of S100A12 displayed no apparent correlation with disease duration and could last for several months in certain patients. These features of the two-tiered innate immune response can further our understanding on the disease mechanism of COVID-19 and may have implications to the clinical triage. Development of a convenient two-gene protocol for the routine serial monitoring of this two-tiered immune response will be a valuable addition to the existing laboratory tests.

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Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients

Cited by 25 publications

References 55 publications

Critically ill children with SARS-COV-2 Omicron infection at a national children medical center, Guangdong, China

Critically ill children with SARS-COV-2 Omicron infection at a national children medical center, Guangdong, China

Evaluation and clinical practice of pathogens and antimicrobial resistance genes of BioFire FilmArray Pneumonia panel in lower respiratory tract infections

A two-gene marker for the two-tiered innate immune response in COVID-19 patients

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