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Objective To explore the evaluation value of dynamic monitoring of neutrophil/lymphocyte ratio(NLR)in severity of illness and prognosis of bacterial sepsis.Methods Clinical data and laboratory index of 72 cases of patients with bacterial sepsis in ICU of Yangpu Hospital Affiliated to Tongji University were retrospectively analyzed.According to the severity of illness,patients were divided into sepsis group(n=20),severe sepsis group(n=30)and septic shock group(n=22).According to the mortality within 28 d,patients were divided into survival group(n=47),death group(n=25).The 0 h NLR,48 h NLR and change rate of NLR between two groups were compared,and the influence factors of prognosis were analyzed.Results With the increase of severity of illness,the time of mechanical ventilation was shortened((8.8±1.9)d,(4.6±0.6)d,(3.9±0.4)d),and PLT((146.4±45.8)×109/L,(110.6±41.3)×109/L,(102.5±38.6)×109/L),NLR rate(0.61±0.26,0.26±0.11,0.22±0.09)were decreased significantly,APEACHE Ⅱ score,CRP,PCT,0 h NLR,48 h NLR were increased obviously((18.5±2.3)points,(20.4±3.6)points,(23.1±3.9)points;(72.6±10.4)mg/L,(78.2±11.6)mg/L,(85.2±12.5)mg/L;(1.5±0.4)μg/L,(2.3±0.6)μg/L,(2.7±0.9)μg/L;11.3±2.6,14.2±3.4,15.7±3.5;3.4±0.9,9.7±2.4,11.2±2.6),the differences were statistically significant(P＜0.05).Compared with death group,the time of mechanical ventilation in survival group was prolonged((4.1±0.3)d vs.(8.7±1.4)d),APEACHE Ⅱ score,CRP,PCT,0 h NLR,48 h NLR were decreased obviously((21.4±3.5)points vs.(18.3±2.6)points,(78.2±11.6)mg/L vs.(71.5±10.8)mg/L,(2.5±0.7)μg/L vs.(1.4±0.6)μg/L,(15.0±3.3)vs.(11.6±2.4),(10.5±2.8)vs.(3.2±0.8)),and PLT,NLR rate were increased significantly((106.5±41.5)×109/L vs.(148.4±50.8)×109/L,0.24±0.10 vs.0.65±0.24),the differences were statistically significant(t=16.18,4.26,2.44,6.99,5.01,16.73,3.54,8.15,P＜0.05).Multivariate logistic regression analysis showed that APEACHE Ⅱ score,0 h NLR were the independent risk factors of death in patients with bacterial sepsis(OR=3.99,3.01,95％CI:1.65-2.38,1.99-4.54,P＜0.05),and NLR rate was independent protection factor(OR=0.95,95％CI:0.91-0.97,P＜0.05).Conclusion Dynamic monitoring of peripheral blood NLR can help to judge the prognosis and severity of illness of patients with bacterial sepsis,and NLR before treatment and change rate of NLR are an independent predictors of death.
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Sepsis in premature is a major cause of morbidity and mortality.The definition of neonatal sepsis is complicated by the frequent presence of noninfectious conditions that resemble those of sepsis,especially in very low-birth-weight preterm infants.Although growth of an organism from a sterile site is the gold standard for definitive diagnosis,the positive rate is low.Therefore,assessment of history,risk factors,sepsis screening scores in combination with diagnostic tests are used to identify neonates who are more likely to be infected.Methods studied to prevent infection include improved hand hygiene,early feedings,immune globulin administration,prophylactic antimicrobial administration.It improves prognosis for early diagnosis and antibiotic administration.
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OBJECTIVE: There are limited data regarding the antimicrobial resistance patterns of pathogens in children with HIV/AIDS from developing countries. We aimed to determine the prevalence and antibiotic susceptibility patterns of bacterial pathogens causing urinary tract infections (UTIs) and sepsis in a cohort of 219 HIV-infected Jamaican children. METHODS: This cross-sectional study examined clinical and microbiological data for children enrolled in the Kingston Paediatric/Perinatal HIV/AIDS programme from September 1, 2002 to May 31, 2007. Cases were defined as physician-diagnosed, laboratory confirmed UTIs and sepsis based on Centers for Disease Control and Prevention (CDC) criteria. Only isolates from urine, blood and sterile sites were considered. RESULTS: Forty-four patients (20.1%) accounted for 74 episodes of UTIs and sepsis. Mean number of infections was 1.7 ± 1.3 per patient. There were 31 males (70.5%) and mean age at time of infection was 5.6 ± 4.7 years. Bacterial infections comprised cystitis (n = 52, 70.3%), bacterial pneumonia (n = 15, 20.3%), meningitis (n = 4, 5.4%), septicaemia (n = 2, 2.7%) and bone infection (n = 1, 1.4%). Among 52 UTIs, 39 were caused by a single organism. The most common UTI isolates included Escherichia coli (n = 21, 53.8%) and Enterobacter spp (n = 5, 12.8%). Among 22 cases of sepsis, isolates included Streptococcus pneumoniae (n = 8, 36.4%) and coagulase negative Staphylococcus (n = 6, 27.3%). All E coli isolates at two of three clinical sites were resistant to cotrimoxazole. There were 79.7% (n = 51) of infectious episodes with a cotrimoxazole-resistant organism occurring among those on cotrimoxazole prophylaxis. CONCLUSIONS: Escherichia coli was the most frequent bacterial isolate. Cotrimoxazole is a poor choice for empiric treatment of sepsis and UTIs in this clinical setting.
OBJETIVO: Los datos existentes en relación con los patrones de resistencia antimicrobiana en los ninos con VIH/SIDA de los países en vías de desarrollo, son limitados. Nuestro objetivo fue determinar la prevalencia y los patrones de susceptibilidad antibiótica de los patógenos bacterianos que causan infecciones de las vías urinarias (IVU) y sepsis en una cohorte de 219 ninos jamaicanos infectados con VIH. MÉTODOS: Este estudio transversal examinó datos clínicos y microbiológicos de ninos enrolados en el programa KPAIDS del 1ero. de septiembre de 2002 al 31 de mayo de 2007. Los casos se definieron como IVU y sepsis de diagnóstico médico, confirmada en el laboratorio, a partir de criterios de los Centros de Control y Prevención de Enfermedades (CCE). Solamente se tuvieron en cuenta aislados de orina, sangre y sitios estériles. RESULTADOS: Cuarenta y cuatro pacientes (20.1%) dieron lugar a 74 episodios de IVU y sepsis. El número promedio de infecciones fue 1.7 ± 1.3 por paciente. Hubo 31 varones (70.5%) y la edad promedio en el momento de la infección fue 5.6 ± 4.7 anos. Las infecciones bacterianas abarcaron: cistitis (n = 52, 70.3%), pulmonía bacteriana (n = 15, 20.3%), meningitis (n = 4, 5.4%), septicemia (n = 2, 2.7%) e infección ósea (n = 1, 1.4%). De las 52 IVU, 39 fueron causadas por un solo microorganismo. Los aislados más comunes de IVU incluyeron Escherichia coli (n = 21, 53.8%) y Enterobacter spp (n = 5, 12.8%). De los 22 casos de sepsis, los aislados incluyeron Streptococcus pneumoniae (n = 8, 36.4%) y Staphylococcus coagulasa negativo (n = 6, 27.3%). Todos los aislados de E coli en dos o tres sitios clínicos eran resistentes al cotrimoxazol. Se produjeron 79.7% (n = 51) episodios infecciosos con un organismo resistente al cotrimoxazol entre los pacientes que se hallaban bajo profilaxis con cotrimoxazol. CONCLUSIONES: Escherichia coli fue el aislado bacteriano más frecuente. El cotrimoxazol es una opción pobre para el tratamiento empírico de sepsis e IVU en esta situación clínica.
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Niño , Preescolar , Femenino , Humanos , Masculino , Farmacorresistencia Microbiana , Seropositividad para VIH/inmunología , Huésped Inmunocomprometido , Sepsis/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológico , Western Blotting , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Jamaica , Pruebas de Sensibilidad Microbiana , Reacción en Cadena de la Polimerasa , Sepsis/inmunología , Sepsis/microbiología , Infecciones Urinarias/inmunología , Infecciones Urinarias/microbiologíaRESUMEN
La sepsis es una enfermedad severa que puede afectar a cualquier miembro de la población, causando graves consecuencias e incluso la muerte si no es tratada a tiempo. Está presente en un alto porcentaje en la población mundial y es la causa de muerte #23 en nuestro país, por ésta razón es de gran relevancia hacer un diagnóstico rápido y seguro de la enfermedad y así proporcionar tratamiento a la población afectada. El objetivo de este estudio fue determinar la sensibilidad, especificidad y exactitud de BRAHMS PCT®-Q, siendo éste una prueba para determinación de niveles de procalcitonina en sangre de manera semicuantitativa, para el diagnóstico precoz de sepsis y comparándolo con los resultados obtenidos por el hemocultivo y la impresión diagnóstica médica, siendo ésta última la prueba de referencia para el diagnóstico de sepsis bacterial. A partir de esto establecer la utilidad, así como los beneficios de una marcador de sepsis como la BRAHMS PCT®-Q en nuestro país. Para lograr esto se utilizó muestras de 102 pacientes que asistieron al Hospital de Clínicas Caracas, cuya sintomatología indicó que era recomendable realizar hemocultivo y determinación de procalcitonina. A estos pacientes se les hizo una toma de muestra para hemocultivo y en la misma punción se tomó una muestra de sangre sin anticoagulante. El hemocultivo fue procesado por el servicio de Bacteriología del Laboratorio del Hospital de Clínicas Caracas y el suero se utilizó para la determinación de procalcitonina. Una vez obtenidos ambos resultados se cotejaron y compararon. A partir de los datos obtenidos se pudo concluir que la sensibilidad de BRAHMS PCT®-Q es mayor al 80%, la especificidad es de 90% y presenta una exactitud de 90%. Por lo tanto es una prueba que puede ser utilizada para el diagnóstico precoz de sepsis...
Sepsis is a serious disease that may affect any member of the population and can have important consequences, including death, if not treated in time. It is present in a high percentage of the World population and is the 23rd cause of death in our country; it is therefore extremely relevant to diagnose the disease quickly and reliably and thus provide treatment to the affected population. The objective of this study consisted in determining the sensitivity, specificity and accurateness of the BRAHMS PCT®-Q, as a test to determine the levels of blood procalcitonin in a semi-quantitative manner for the early diagnosis of sepsis and comparing it with the results of the blood culture and medical impression, which is the benchmark test for the diagnosis of bacterial sepsis. And based on this, to establish the usefulness, as well as the benefits, of a sepsis marker, such as the BRAHMS PCT®-Q, in our country. To do so, samples of 102 patients, who visited the Hospital de Clínicas Caracas, were used; their symptomatology indicated that it was advisable to conduct a blood culture and determine procalcitonin. Of these patients a sample was taken for the blood culture, and with the same puncture a blood sample was taken without anticoagulant. The blood culture was processed using the services of the Bacteriological Department of the Hospital de Clínicas Caracas, and the serum was used to determine procalcitonin. Once both results were in, they were cross-tabulated and compared. Based on the data that was obtained, it could be concluded that the sensitivity of BRAHMS PCT®-Q is greater than 80%, its specificity is 90% which represents an accurateness of 90%. It is therefore a test that can be used for the early diagnosis of sepsis, but it is even more recommended to rule out the same...