Predictive role of selected biomarkers in differentiating gram-positive from gram-negative sepsis in surgical patients: a retrospective study.

INTRODUCTION: Patients after major surgery are at high risk of developing sepsis, which is accompanied by elevated serum levels of C-reactive protein (CRP) and procalcitonin (PCT). This study aimed to examine the differences in serum biomarker levels concerning the causative agent of sepsis in surgical patients. MATERIAL AND METHODS: A retrospective study was carried out in the surgical intensive care unit (ICU) and included 81 septic patients admitted from January 2019 to May 2022, who had positive blood cultures (BC). Serum levels of PCT, CRP, white blood cells (WBC) and platelet counts were recorded on the day of the positive BC and over the following 3 days. RESULTS: Patients with gram(-) sepsis had significantly higher PCT levels, and lower platelet count compared to patients with gram(+) sepsis. High PCT and low platelets levels in all measurements were a significant predictor of gram(-) isolate with the highest predictive value on the third day after BC sampling, with AUROC 0.821 (95% CI: 0.692-0.950), P = 0.001, and AUROC 0.676 (95% CI: 0.541-0.811), P = 0.02, respectively. In multivariate logistic regression, platelets the day after BC sampling and PCT on the third day made a significant contribution in distinguishing gam(+) from gram(-) BC. Age and high serum CRP levels were significant predictors of poor outcomes. CONCLUSIONS: PCT and platelets may be useful biomarkers for predicting the causative agent of sepsis in surgical patients.

Fatal fulminant sepsis due to a cat bite in an immunocompromised patient.

Pasteurella multocida infections in humans can present as localized infections of soft tissues surrounding the lesions, as respiratory tract infections or as systemic infections with slow or fulminant development. Over 90% of human infections are cases of wound infections or abscesses related to a bite, scratch, or licking of skin lesions by a cat or dog. Severe systemic diseases such as pneumonia, lung abscess, peritonitis, endocarditis, meningitis and sepsis are also well known, especially in patients with underlying medical conditions. In this paper we report on an immunocompromised patient who was bitten by an unknown cat and very quickly developed fulminant sepsis, dying 70 hours after the cat bite, despite all the intensive care, therapy and reanimation he was given. Unfortunately, he asked for medical help too late. We emphasize the need for primary healthcare to provide more information to patients at risk of infections from contact with animals and to warn them about the possible consequences of injuries, even when the animals are pets.