Cost analysis of real-time polymerase chain reaction microbiological diagnosis in patients with septic shock.

Antibiotic treatment for septic shock is generally prescribed on an empirical basis using broad-spectrum antibiotics. Molecular diagnostic techniques can detect the presence of microbial DNA in blood within a few hours and facilitate early, targeted treatment. The aim of this study was to evaluate the economic impact of a real-time polymerase chain reaction technique, LightCycler SeptiFast (LSC), in patients with sepsis. A cost-minimisation study was carried out in patients admitted with a diagnosis of severe sepsis or septic shock to the intensive care unit of a university hospital. The stay in the intensive care unit, hospital admission, 28-day and six-month mortality, and the economic cost of the clinical process were also evaluated. The study involved 48 patients in the LSC group and 54 patients in the control group. The total cost was €42,198 in the control group versus €32,228 in the LCS group with statistically significant differences (P <0.05), giving rise to an average net saving of €9970 per patient. The mortality rate was similar in both groups. The main finding of this study was the significant economic saving afforded by the use of the LCS technique, due to the shortening of intensive care unit stay and the use of fewer antibiotics.

Meningitis neonatal por enterovirus. Experiencia de un caso y revisión del tema / Enterovirus induced neonatal meningitis. A case report and review of the subject

Presentamos un caso de meningitis por enterovirus diagnosticada mediante reacción en cadena de polimerasa en una recién nacida en 37 semanas de edad gestacional y seis días de vida, de probable etiología congénita. Las infecciones por enterovirus constituyen una causa frecuente de infección en recién nacidos pese a no estar incluidas en el diagnóstico diferencial habitual de la sepsi neonatal. La presencia de clínica materna compatible puede orientar el diagnóstico en los casos de transmisión vertical. Su identificación precoz en estos casos permite acortar el tratamiento antibiótico empírico innecesario y la hospitalización y realizar un adecuado seguimiento de las posibles complicaciones. El tratamiento antiviral con pleconaril se contempla en casos graves, aunque actualmente la indicación de tratamiento en neonatos no está bien establecida. El caso descrito siguió una evolución favorable con pruebas de neuroimagen y seguimiento neurológico hasta los seis meses de vida normal. En el trabajo se revisan las manifestaciones clínicas, el diagnóstico y las perspectivas actuales de tratamiento de las infecciones neonatales pro enterovirus (AU)

We report a case of a 36 week gestational age female diagnosed with enterovirus meningitis by polymerase chain reaction at 6 days of age, probably by congenital transmission. Enterovirus are a common cause of neonatal infection, frequently under diagnosed because they are not usually included in the differential diagnoses of the neonatal sepsis. Maternal compatible symptoms could help to the diagnoses in the cases with vertical transmission. An early enterovirus identification may reduce the length of antibiotic treatment and hospitalization and allow an accurate follow up, alerting of complications. Antiviral treatment with pleconaril is accepted in severe cases, but nowadays there is a lack of consensuate indication for the treatment of neonatal a enterovirus infections. The evolution of the present case was favorable with a normal neurological development until the sixth month of age and without abnormalities in the neuroimaging. This article reviews the clinical manifestations, the diagnoses and the potential treatment for enterovirus infections in (AU)