Use of biomarkers in the prediction of culture-proven infection in the surgical intensive care unit

Ghabra, Hussam; White, William A.; Townsend, Michael C.; Boysen, Philip G.; Nossaman, Bobby D.

doi:10.1016/j.jcrc.2018.10.023

Cited by 4 publications

(3 citation statements)

References 50 publications

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“…Procalcitonin should be interpreted cautiously in certain populations in which it has not been extensively studied (eg, immunocompromised) or in noninfectious conditions that may elevate procalcitonin, such as major physiologic stress (eg, surgery, trauma, burns) and end-stage renal disease. [12][13][14] Further Abbreviations: CAP, community acquired pneumonia, PCT, procalcitonin investigation is needed to determine the efficacy and safety of procalcitonin-guided antibiotic therapy in these populations.…”

Section: Discussionmentioning

confidence: 99%

Clinical Progress Note: Procalcitonin in the Diagnosis and Management of Community‐Acquired Pneumonia in Hospitalized Adults

Choi¹,

McCarthy²,

Simon³

et al. 2019

Journal of Hospital Medicine

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Community-acquired pneumonia (CAP) accounts for more than 1.5 million adult hospitalizations and 100,000 deaths each year in the United States.1 Antibiotic overuse in the hospital setting is an important contributor to the rise of antibiotic resistance, prompting increased efforts to limit inappropriate antibiotic use in hospitals.2 Procalcitonin, a precursor of the hormone calcitonin, is upregulated in bacterial infections and downregulated in viral infections. The US Food and Drug Administration has approved it as a serum biomarker to assist clinicians with decisions about using antibiotics.3 There is no consensus on how to best use procalcitonin in the management of CAP. We provide a practical update that includes a review of recent literature, added secondary analysis, and expert opinion surrounding the use of procalcitonin in the diagnosis and management of CAP in hospitalized adults.

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Section: Discussionmentioning

confidence: 99%

Clinical Progress Note: Procalcitonin in the Diagnosis and Management of Community‐Acquired Pneumonia in Hospitalized Adults

Choi¹,

McCarthy²,

Simon³

et al. 2019

Journal of Hospital Medicine

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“…Diagnosis requires a composite of information, including history, physical examination, radiographic findings, and laboratory data. Detailed and accurate medical history, combined with some rapid laboratory methods, for example, biomarkers, [22,23] gene sequencing, rapid microscopy, and radiologic findings, may help establish the diagnosis of infection as early as possible. It must be emphasized that both medical history and examination are essential for the establishment of an infection diagnosis.…”

Section: Right Patients: Rapid Screening and Early Diagnosismentioning

confidence: 99%

Rules of anti-infection therapy for sepsis and septic shock

Zhou

Zhang

et al. 2019

Chinese Medical Journal

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Objective:Sepsis is a deadly infection that causes injury to tissues and organs. Infection and anti-infective treatment are the eternal themes of sepsis. The successful control of infection is a key factor of resuscitation for sepsis and septic shock. This review examines evidence for the treatment of sepsis. This evidence is combined with clinical experiments to reveal the rules and a standard flowchart of anti-infection therapy for sepsis.Data Sources:We retrieved information from the PubMed database up to October 2018 using various search terms and their combinations, including sepsis, septic shock, infection, antibiotics, and anti-infection.Study Selection:We included data from peer-reviewed journals printed in English on the relationships between infections and antibiotics.Results:By combining the literature review and clinical experience, we propose a 6Rs rule for sepsis and septic shock management: right patients, right time, right target, right antibiotics, right dose, and right source control. This rule encompasses rational decisions regarding the timing of treatment, the identification of the correct pathogen, the selection of appropriate antibiotics, the formulation of a scientifically based antibiotic dosage regimen, and the adequate control of infectious foci.Conclusions:This review highlights how to recognize and treat sepsis and septic shock and provides rules and a standard flowchart for anti-infection therapy for sepsis and septic shock for use in the clinical setting.

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“…14 In addition, some report that PCT should be used in conjunction with other biomarkers such as lactate. 15 While PCT has an emerging role in the early identification of likely infection in many acute settings, PCT levels may also become elevated with inflammatory states that are not triggered by infection which can present a challenge particularly in the postoperative setting. The postsurgical population is a unique cohort in whom accurate and timely diagnosis of infection is of extreme importance but can be challenging because surgery itself can trigger the inflammatory cascade which in turn can elevate the traditional markers of inflammation including white blood cell count, C-reactive protein, and proinflammatory cytokines.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Procalcitonin in Predicting Infection in Children Undergoing Surgical Procedures

Bavare

Rissmiller

Devaraj

et al. 2021

Journal of Surgical Research

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Background: Procalcitonin (PCT) is a biomarker of bacterial infections with more sensitivity and specificity than commonly used inflammatory markers. PCT can be particularly helpful in the postsurgical population where the surgery itself often leads to noninfectious inflammation. We aimed to examine the utility of perioperative profiles of PCT in predicting infection in two pediatric surgical populations. Methods:We conducted a prospective observational study of perioperative PCT in children undergoing cardiac or neurosurgery. Consenting patients with no preoperative infection or immune deficiency were enrolled. We measured plasma PCT levels within 24 h preprocedure and 24-48 h postprocedure. Demographic, clinical, and laboratory data were collected from the medical records including clinical suspicion and confirmed infections.Perioperative PCT changes and their associations with these data are reported.Results: We enrolled 26 neuro and 15 cardiac surgery patients. There was postoperative clinical suspicion of infection in 3 neuro and 5 cardiac patients, and 1 neuro and 2 cardiac patients had subsequently confirmed infections. Cardiac patients had higher overall perioperative PCT increase than neuro cohort (P ¼ 0.006). Neuro patient with infection had higher perioperative change in PCT (0.5 to 1.4 ng/mL) than noninfected neurosurgery patients. Cardiac patients with confirmed infections had higher postoperative levels which exceeded the previously described infection threshold of 2 ng/mL. Conclusions: PCT is a useful early biomarker of postoperative infection in pediatric patients undergoing cardiac and neurosurgery. Patients who underwent cardiac surgery have significantly higher perioperative PCT rise than patients who underwent neurosurgery, and all patients with subsequently confirmed infections had at least 2-fold perioperative PCT increase.

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Use of biomarkers in the prediction of culture-proven infection in the surgical intensive care unit

Cited by 4 publications

References 50 publications

Clinical Progress Note: Procalcitonin in the Diagnosis and Management of Community‐Acquired Pneumonia in Hospitalized Adults

Clinical Progress Note: Procalcitonin in the Diagnosis and Management of Community‐Acquired Pneumonia in Hospitalized Adults

Rules of anti-infection therapy for sepsis and septic shock

Perioperative Procalcitonin in Predicting Infection in Children Undergoing Surgical Procedures

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