Assessing the Utility of Multiplexed Polymerase Chain Reaction in Detecting Microorganisms Causing Infections in Critically ill Patients.

Early sepsis diagnosis is crucial for implementing adequate antibiotic therapy and for patient survival. This study investigated whether using multiplexed PCR for detecting microorganisms in critical septic patients affects initial antibiotic treatment and compared it to microbiological culture. It also explored scenarios where PCR is more effective in clinical practice. One hundred nineteen specimens (83 blood and 36 respiratory specimens) belonging to 93 patients were analyzed. Multiplexed PCR determinations were performed using the FA-BCID Panel (bioMérieux) for blood samples and the FA-Pneumo for respiratory samples. The mean turnaround times were 1.7 h for the FA-BCID and 1.5h for the FA-Pneumo. Conversely, they were 96.1 h for blood cultures and 72.3 h for respiratory cultures. FA-BCID showed a mean sensitivity of 97% and specificity of 100%. FA-Pneumo showed a sensitivity of 100% and specificity of 90%. However, the positive predictive value was only 39%. Discrepancies were common in polymicrobial samples. Based on the PCR results, initial empirical treatment should have been changed in 71% of patients with bloodstream infections and 61% with respiratory infections. We conclude that multiplexed PCR improves the response time in identifying germs with a high degree of coincidence for blood cultures and moderate for respiratory cultures. These results highlight the importance of PCR in choosing an appropriate antibiotic therapy.

Study of the Plasma and Buffy Coat in Patients with SARS-CoV-2 Infection-A Preliminary Report.

The pandemic caused by the SARS-CoV-2 infection affects many aspects of public health knowledge, science, and practice around the world. Several studies have shown that SARS-CoV-2 RNA in plasma seems to be associated with a worse prognosis of COVID-19. In the present study, we investigated plasma and buffy RNA in patients with COVID-19 to determine its prognostic value. A prospective study was carried out in patients hospitalized for COVID-19, in which RNA was analyzed in plasma and the buffy coat. Morphological and immunohistochemical studies were used to detect the presence of SARS-CoV-2 in the buffy coat. In COVID-19 patients, the obtained RNA concentration in plasma was 448.3 ± 31.30 ng/mL. Of all the patients with positive plasma tests for SARS-CoV-2, 46.15% died from COVID-19. In four cases, tests revealed that SARS-CoV-2 was present in the buffy coat. Abnormal morphology of monocytes, lymphocytes and neutrophils was found. An immunohistochemical study showed positivity in mononuclear cells and platelets. Our results suggest that SARS-CoV-2 is present in the plasma. This facilitates viral dissemination and migration to specific organs, where SARS-CoV-2 infects target cells by binding to their receptors. In our study, the presence of plasma SARS-CoV-2 RNA was correlated with worse prognoses.

Clinical value of procalcitonin in critically ill patients infected by SARS-CoV-2.

Background Blood procalcitonin (PCT) levels usually increase during infectious diseases and might be helpful to differentiate bacterial from non-bacterial origin. COVID-19 patients could present co-infections at initial presentation in the Emergency Department and nosocomial infections during stay in the ICU. However, the published literature has not established whether PCT changes could aid in the diagnosis of infectious complication during the COVID-19 pandemic. Methods Retrospective, single-center, cohort study, including COVID-19 patients admitted between March and May 2020. The data were prospectively collected for department purposes; laboratory results were collected automatically at admission and during the whole patient admission. Results 56 patients were analyzed (female 32%, male 68%), 35 were admitted to ICU, and 21 received general ward care. 21 ICU patients underwent mechanical ventilation (88%), and 9 died during admission (26%). Non-survivors had higher initial blood PCT levels than survivors at ICU admission (p.

Effect of continuous renal-replacement therapy on paraoxonase-1-related variables in patients with acute renal failure caused by septic shock.

BACKGROUND: Acute renal failure in patients with sepsis is associated with high mortality. Studies have highlighted alterations in serum paraoxonase-1 in severe infections. However, the published literature has no insight into the clinical evolution of these parameters in patients with sepsis and acute renal failure treated with extra-renal depuration techniques. METHODS: We studied 25 patients with sepsis and acute renal failure who were treated with continuous renal-replacement therapy. Blood for laboratory analyses was collected at days 0, 1, 2, 5, 7, and 10. We measured serum paraoxonase-1 activity and concentration, lipid profile, aminotransferase activities, pH, and lactate, urea, creatinine and C-reactive protein concentrations. Values were compared with those of 50 healthy individuals. RESULTS: Patients with sepsis and acute renal failure had lower serum paraoxonase-1 activity, lower high-density lipoprotein cholesterol concentrations, and higher serum paraoxonase-1 concentrations than the control group. We found a significant inverse correlation between serum paraoxonase-1 concentrations and the Acute Physiology And Chronic Health Evaluation II score in survivors as well as non-survivors, and a significant inverse correlation between serum paraoxonase-1 concentrations and the Sequential Organ Failure Assessment score only in survivors. Extra-renal depuration techniques produced a further increase in this enzyme related to the duration of treatment, and to serum urea concentration. CONCLUSION: Our results show an inverse relationship between the concentration of paraoxonase-1 and the disease severity of patients with renal failure caused by septic shock. These results highlight relationships between paraoxonase-1 and infectious diseases and sepsis, with insights into potential clinical evolution of treatment.

Emergence of daptomycin-resistant Enterococcus faecium in a critically ill patient with postoperative intra-abdominal sepsis / Aparición de Enterococcus faecium resistente a daptomicina en un paciente crítico con sepsis intraabdominal postoperatoria

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