Daily monitoring of biomarkers of sepsis in complicated long-term ICU-patients: can it support treatment decisions?

BACKGROUND: Diagnosis/grading of infection and the systemic response to infection may be difficult on admission to the intensive care unit, but it is even more complicated for severely ill patients with long intensive care stays. The ACCP-SCCM criteria are difficult to apply for such patients, and objective, validated biomarkers would be of great use in this setting. METHODS: Long-term (>6 days) critically ill patients in the general ICU of University Hospital were prospectively enrolled in the study. All patients were assessed daily by the attending physician using the ACCP-SCCM classification. C-reactive protein (CRP, mg/dL), procalcitonin (PCT, ng/mL), and interleukin-6 (IL-6, pg/mL) of daily stored sera were measured after each patient's discharge. After discharge, an independent, overall clinical evaluation and an a posteriori ACCP-SCCM classification were chosen as the reference standard for all comparisons. The assessor was aware of the patient's clinical course but was blinded to levels of biomarkers. RESULTS: We studied clinical variables and biomarkers of 26 patients over a total of 592 patient days. The day-by-day ACCP-SCCM classification of the attending physician overestimated the severity of the inflammatory response to infection. The diagnostic discriminative ability of severe-sepsis/septic-shock for PCT was high (ROC area 0.952 [0.931-0.973]) and had a best threshold value of 1.58 (83.7% sensitivity, 94.6 % specificity). IL-6 had better discriminative ability than CRP, but both were worse than PCT. CONCLUSION: PCT > 0.43 ng/mL could add to the clinical propensity for sepsis vs. SIRS not related to infection. Values higher than 1.58 ng/mL may support the bedside clinical diagnosis of severe-sepsis. PCT between 0.5 and 1.0 suggest tight daily monitoring of clinical conditions and re-evaluation of PCT.

[Identification of staphylococci of clinical importance: evaluation of available commercial kits and technical notes on the reduction of response time and cost of performance]. / Identificazione degli stafilococchi di interesse clinico: valutazione di kits disponibili in commercio e note di tecnica sulla riduzione dei tempi di risposta e costi di esecuzione.

A study was carried out on 150 strains of staphylococci of human origin in order to evaluate the possibility of achieving identification that is accurate, swift and perhaps economical, with the following aims in mind: a) the testing of fast systems for the detection of coagulase of Staphyslide and Sero Stat compared with classical coagulase in a test tube with EDTA and citrate; b) the evaluation of the API Staph system by comparing identification obtained through subculturing the strains in agar P, as suggested by manufacturers, with those that have been streaked directly with material on triptose agar. All the experiments were carried out in both laboratories and in double blindness. The strains of Staphylococcus aureus were 88, 90 and 98% respectively, identified by the Staphyslide, Sero Stat and coagulase in a test tube. The same results were obtained by greatly reducing the amount of the kits reactive substance. The facts show that system can take place in the microbiological laboratory to improve screening processes. The API Staph system identified 96% of all the strains and 89% of negative coagulase. The methods used to identify through primary culture in triptose are mirrored with subculture from agar P. Using this medium to streak urine, one can expect to prepare the recognition of the isolated strains the day before.

[Annual usage in a general hospital of antimicrobials and frequency of resistant bacterial strains (author's transl)]. / Consumo di antibiotici e resistenza batterica in ambiente ospedaliero.

The data concerning annual usage in a general hospital and the frequency of resistant bacterial strains, isolated from patients with urinary tract's infection from 1975 to 1977 were collected and statistically processed. It was noticed that the year by year variation of resistance were mainly confined to E. coli and P. mirabilis. Increasing resistance with time was found for E. coli with Co-trimoxazole, P. mirabilis with Cephaloridin and Gentamicin, Proteus indole-positive with Rifampicin. Reducing resistance with time was found for E. coli with Colistin and Rifampicin, and Klebsiella-Enterobacter with Rifampicin. Trende with usage were found for E. coli and Klebsiella-Enterobacter with Rifampicin (decreasing) and P. mirabilis with Cephalorin (increasing). Naturally, none of the above trends imply cause and effect.