Performance enhancement of procalcitonin by high-sensitivity C-reactive protein at the optimal cutoff in predicting bacteremia in emergency department adult patients.

Pathogenic bacteremia portends a high mortality risk in adult patients admitted to an Emergency Department (ED). This study aims to investigate the effect of adding high-sensitivity C-reactive protein (hs-CRP) to procalcitonin (PCT) and lactate in predicting bacteremia, Gram-negative (GNB) and Gram-positive bacteremia (GPB), using the optimal cutoff derived from the receiver operating characteristics analysis. We evaluated the diagnostic measures, including the positive-test likelihood (LR+), the negative-test likelihood (LR-), and the diagnostic odds ratio (DOR) using a single-center retrospective analysis design. This Standards for Reporting Diagnostic-compliant study comprised 886 consecutive adults who were admitted to the ED in 2010; to this cohort, a 22.2% prevalence of true bacteremia was subsequently confirmed. At the cutoff of 3.9 µg/L, PCT had a DOR of 5.3 (95% confidence interval [CI]: 3.76-7.61) and LR + of 2.8 (95% CI: 2.3-3.4) in predicting overall bacteremia. Elevated PCT and lactate (cutoff at 2 mmol/L), increased the DOR and LR + to 6.3 (95% CI: 4.27-9.29) and 4.0 (95% CI: 3.1-5.2). The DOR and LR + were further improved to 7.1 (95% CI: 4.2-11.95) and 5.6 (95% CI: 3.7-8.6), respectively, when hs-CRP at the cutoff of 1238 nmol/L was added to PCT plus lactate. High-sensitivity CRP at the cutoff of 1,255 nmol/L can enhance the discriminative power raising DOR and LR + values for GPB. The elevation of hs-CRP at the optimal cutoff might improve the diagnostic performance to predict unspecified bacteremia and GPB, but not GNB.

Comparison of pyogenic liver abscess caused by non-Klebsiella pneumoniae and Klebsiella pneumoniae.

From January 1996 to April 2002, a total of 248 patients with pyogenic liver abscess were enrolled in this study. Abscesses caused by Klebsiella pneumoniae accounted for 69% (171) of cases. Abscesses caused by K. pneumoniae were more strongly associated with diabetes mellitus or impaired fasting glucose than liver abscesses caused by non-K. pneumoniae (70.2% vs 32.5%). Solitary abscess and monomicrobial isolates were more frequent in the K. pneumoniae group than that in the non-K. pneumoniae group. A total of 42 patients were treated with antibiotics alone. Antibiotics treatment was combined with other procedures, including single aspiration in 23 patients, percutaneous drainage in 176 and surgical drainage in 7. A higher incidence of metastatic infections occurred in the K. pneumoniae group than in the non-K. pneumoniae group (14.6% vs 3.8%). By contrast, the mortality rate of the K. pneumoniae group was lower than that of non-K. pneumoniae group (4.1% vs 20.8%). There was no significant difference in the relapse rate between these 2 groups (6.5% vs 6.4%). We also found that the presence of respiratory symptoms (including cough, dyspnea, or chest distress), size of abscess > or =5 cm in diameter and non-K. pneumoniae pathogens were significant prognostic factors for mortality.