Diagnostic value of sTREM-1 and procalcitonin levels in the early diagnosis of sepsis.

OBJECTIVE: Sepsis is still major cause of morbidity and mortality, despite improvements in diagnosis and treatment in modern medicine. Therefore, laboratory examinations that provide correct and rapid results are needed to support the diagnosis. This study was conducted to investigate value of immunological indicators procalcitonin (PCT) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in differential diagnosis of patients with sepsis and systemic inflammatory response syndrome (SIRS), as well as to assess their importance in determining prognosis of patients with sepsis. METHODS: Total of 90 patients, 38 with SIRS and 52 with sepsis, who were between the ages 20 to 92, were included in this prospectively planned study. Blood sample was collected from the patients during hospitalization and again in follow-up visit. Enzyme-linked immunosorbent assay (MyBioSource, Inc., San Diego, CA, USA) was used to measure sTREM-1, and PCT was measured using mini VIDAS B.R.A.H.M.S PCT assay (Biomerieux, S.A., Marcy-l'Étoile, France). In addition, patients were clinically assessed using Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system. RESULTS: On day of intensive care unit admission, sTREM-1 and PCT levels, as well as APACHE II score were significantly higher in sepsis group than SIRS group (p=0.001, p=0.01, p=0.001, respectively). Values of sTREM-1 and APACHE II score were higher in the patients with positive blood cultures than those with negative culture results (p=0.002, p=0.006, respectively). PCT, C-reactive protein, and sTREM-1 levels were significantly higher in nonsurviving group. In differentiation of SIRS from sepsis, sTREM-1 cut-off value ≥133 pg/mL and PCT cut-off value of 1.57 ng/mL yielded sensitivity of 71.1% and 67.33%, and specificity of 73.3% and 65.79%, respectively. CONCLUSION: In patients with suspected sepsis, sTREM-1 and PCT can be used as indicators, in addition to scoring systems such as APACHE II and Sepsis-related Organ Failure Assessment score. However, it would be appropriate to support present findings with studies of larger series.

Detection of upper limit of normal values of anti-DNase B antibody in children's age groups who were admitted to hospital with noninfectious reasons.

OBJECTIVE: Anti-streptolysin O (ASO) and anti-DNase B (ADB) titers are used for the diagnosis of poststreptococcal complications. Ranges of normal values of ASO and ADB titers vary, depending on age, population and different time intervals. Although many studies have been performed for determination of the ASO titer in our country, only a few studies have been conducted for specification the upper limit of normal for (ULN) ADB. In our study we aimed to determine the upper limit of normal of ADB antibody titers in children aged 5-15. METHODS: One hundred and twenty one children aged from 5-15 who were admitted to our outpatient clinic of Haydarpasa Numune Training and Research Hospital with noninfectious reasons between November 2013 and March 2014 were included in the study. Patients who met the following criteria were included in the study; absence of streptococcal infection in the last three months in physical examination and/or no growth of group A, C, and G of beta-haemolytic streptococci in throat culture, normal ranges of ASO and C reactive protein (CRP) levels. All serum samples were analyzed collectively by nephelometric method. The upper limit of normal value for anti-DNase B has been defined by separating the upper 20% from the lower 80% of all measurements. RESULTS: Anti-DNase B antibody levels were ranged between 50-576 IU/ml and its upper limit was 219.2 IU/ml. When analyzed according to age groups, anti-DNase B antibody levels in the group aged between 5-10, ranged between 50-576 IU/ml and its upper limit was 212.2 IU/ml, anti-DNase B antibody levels in the group aged 10-15, ranged between 50-408 IU/ml and its upper limit was 231.2 IU/ml (p=0.008). CONCLUSION: Based on our results, upper normal values ADB antibody showed variations with age in our results. Therefore national reference values should be detected by more comprehensive studies.

Efficacy of silver-loaded nanofiber dressings in Candida albicans-contaminated full-skin thickness rat burn wounds.

In this experimental study, the effects of nanofiber dressings containing different forms of silver on full-thickness rat burn contaminated with Candida albicans was analyzed. A full-thickness skin burn was formed on a total of 32 Sprague-Dawley rats. After the burn wound was seeded with a 10 colony-forming units/ml standard strain of Candida albicans ATCC90028, the animals were divided into four groups. The effects of topical silver sulfadiazine and two recently designed nanofiber dressings containing nanosilver and silversulfadiazine as active materials were compared with the control group. There was a significant difference in the Candida growth on the burn eschar tissue among the groups. The difference for Candida growth in the burn eschar between the control group and the 1% silver sulfadiazine-containing nanofiber dressing group was statistically significant (P< 0.01). Silver sulfadiazine-containing nanofiber dressing was the most effective agent in the treatment of Candida albicans-contaminated burn wounds. Because of their regenerative potential, silver-loaded nanofiber dressings could be a good alternative for infected burn wounds.

Gram-negative bacilli causing infections in an intensive care unit of a tertiary care hospital in Istanbul, Turkey.

INTRODUCTION: This study aimed to demonstrate the changing epidemiology of infecting microorganisms and their long-term resistance profiles and to describe the microbiological point of view in anti-infective management of intensive care unit (ICU) patients. METHODOLOGY: A total of 5,690 isolates of Gram-negative bacilli were included in this study. Antibiotic susceptibility was tested using the disk diffusion method and Vitek 2 system. Chi-square tests were used for hypothesis testing. RESULTS: The most frequently isolated organisms were A. baumannii (37.3%), P. aeruginosa (30.3%), Enterobacter spp. (10.4%), E. coli (10.4%), and Klebsiella spp. (8.9%). A. baumannii was the most frequently isolated organism from the respiratory tract (43.4%); the susceptibility rates for imipenem and meropenem decreased to 7% and 6% (p < 0.0001), respectively. The percentage of multidrug-resistant (MDR) A. baumannii isolates continuously increased from 18.7% in 2004 to 69% in 2011 (p < 0.0001), whereas MDR P. aeruginosa isolates increased from 1.5% to 22% (p < 0.0001). Carbapenem-resistant Klebsiella isolates emerged in 2010 and increased to 20% in the next year. The rates of ESBL-producing Enterobacteriaceae in the ICU was very high in 2011 - 50% for E. coli and 80% for Klebsiella strains. CONCLUSION: The most common isolated Gram-negative bacillus in our study was A. baumannii and that the prevalence of MDR isolates has increased markedly over. Accordingly, the comparison of antibiotic resistance of other pathogens in 2004 and 2011 displayed an increasing trend. These data imply the urgent need for new and effective strategies in our hospital and in the region.