ABSTRACT
Introducción. La bacteriemia es una de las principales causas de morbimortalidad en el paciente con cáncer. El objetivo de este estudio es evaluar la utilidad de la procalcitonina como marcador predictor de bacteriemia en pacientes oncológicos y oncohematológicos que acudieron al Servicio de Urgencias de nuestro hospital. Material y métodos. Se incluyeron en el estudio 152 episodios de fiebre en 134 pacientes adultos oncológicos. Al ingreso en el Servicio de Urgencias una muestra de sangre fue extraída para la medida de proteína C reactiva (PCR) y procalcitonina (PCT). Los episodios febriles se clasificaron en dos grupos en función de los resultados del hemocultivo: bacteriémicos (n = 22) y no bacteriémicos (n = 130). El rendimiento diagnóstico de los biomarcadores como predictores de bacteriemia fue calculado mediante el análisis del área bajo la curva Receiver Operating Characteristic. Resultados. Las concentraciones de PCT y PCR fueron significativamente más altas en los episodios febriles con bacteriemia que en los no bacteriémicos. La PCT presentó un rendimiento diagnóstico más alto que la PCR como predictor de bacteriemia (área bajo la curva Receiver Operating Characteristic: PCT 0,781 (IC 95%: 0,667 - 0,895) vs. PCR: 0,632 (IC 95%: 0,493 - 0,771); p = 0,02). Un punto de corte de 0,20 ng/mL presentó un valor predictivo negativo de 95,8% para descartar bacteriemia. Conclusión. En el Servicio de Urgencias, la medida de PCT en pacientes oncológicos con fiebre es una herramienta útil para descartar bacteriemia y puede contribuir a la toma inicial de decisiones terapéuticas y a racionalizar la solicitud del hemocultivo (AU)
Aim. Bacteraemia is one of the most important causes of morbidity and mortality in cancer patients. The aim of this study was to evaluate the usefulness of procalcitonin for predicting bacteraemia in febrile oncology and oncohaematology patients admitted to the Emergency Department of our hospital. Material and methods. The study included a total of 152 febrile episodes in 134 adult cancer patients. A blood sample was collected on admission to the Emergency Department to measure C-reactive protein (CRP) and procalcitonin (PCT). Febrile episodes were classified into two groups according to the blood culture results: bacteraemia episodes (n = 22) and non-bacteraemia episodes (n = 130). Receiver Operating Characteristic curve analysis was performed for each biomarker as a predictor of bacteraemia. Results. PCT and CRP levels were significantly higher in the bacteraemia episodes group when compared with non-bacteraemia episodes group. PCT showed a diagnostic accuracy higher than CRP for predicting bacteraemia (AUC Receiver Operating Characteristic: PCT 0,781 (95% CI: 0,667 - 0,895) vs. CRP: 0,632 (95% CI: 0,493 - 0,771); p = 0,02). A cut-off value of 0,20 ng/mL was associated with a negative predictive value of 95,8% to rule-out bacteraemia. Conclusion. PCT measurement in febrile cancer patients in the Emergency Department is a useful tool to rule-out bacteraemia, and may contribute in initial therapeutic decision making and rationalise the request for blood culture (AU)
Subject(s)
Humans , Male , Female , Adult , Calcitonin/analysis , Calcitonin , Bacteremia/diagnosis , Neoplasms/complications , Polymerase Chain Reaction/methods , Polymerase Chain Reaction/trends , Laboratory Test/methods , Fever/complications , Fever/diagnosis , Fever/etiology , Indicators of Morbidity and Mortality , Prospective Studies , Diagnosis, DifferentialABSTRACT
Introducción En las últimas décadas se ha detectado un incremento progresivo de las infecciones graves producidas por Streptococcus pyogenes o estreptococo beta-hemolítico del grupo A (SGA). Métodos Estudio descriptivo retrospectivo de los 13 casos de bacteriemia por S. pyogenes entre enero de 2009 y enero de 2013 en Cartagena. Se calcula la incidencia anual para la enfermedad grave bacteriémica. Resultados La incidencia se incrementó de 0,37 en 2009 a 2,5 casos/100.000 habitantes en 2012. El foco predominante fue la piel y los tejidos blandos (53%). La mortalidad precoz atribuible fue del 20%. Conclusión Se trata de una patología poco frecuente que afecta a individuos previamente sanos y que se relaciona con una elevada mortalidad(AU)
Introduction A gradual increase in severe cases due to Streptococcus pyogenes or Streptococcus beta-hemolytic group A (SGA), has been detected in the last few decades. Methods Retrospective study of bacteremia due to S. pyogenes detected between January 2009 and January 2013 in Cartagena. The annual incidence for severe bacteremia has been estimated. Results Thirteen cases of SGA bacteremia were recorded. The incidence increased from 0.37 in 2009 to 2.5 cases/100,000 inhabitants in 2012. The predominant focus was skin and soft tissue infections (53%). Early mortality was 20%. Conclusion Severe streptococcal disease is rare, but affects individuals with good functional status, and is associated with a high mortality(AU)
Subject(s)
Humans , Streptococcus pyogenes/pathogenicity , Streptococcal Infections/epidemiology , Bacteremia/epidemiology , Retrospective StudiesABSTRACT
INTRODUCTION: A gradual increase in severe cases due to Streptococcus pyogenes or Streptococcus beta-hemolytic group A (SGA), has been detected in the last few decades. METHODS: Retrospective study of bacteremia due to S.pyogenes detected between January 2009 and January 2013 in Cartagena. The annual incidence for severe bacteremia has been estimated. RESULTS: Thirteen cases of SGA bacteremia were recorded. The incidence increased from 0.37 in 2009 to 2.5 cases/100,000 inhabitants in 2012. The predominant focus was skin and soft tissue infections (53%). Early mortality was 20%. CONCLUSION: Severe streptococcal disease is rare, but affects individuals with good functional status, and is associated with a high mortality.
