Clinical Significance of Interleukin-6 in the Diagnosis of Sepsis and Discriminating Sepsis Induced by Gram-negative Bacteria.

BACKGROUND: To discuss the clinical significance of interleukin (IL)-6 in the differential diagnosis of sepsis and its capability of differentiating the sepsis induced by Gram-negative bacteria from that induced by Gram-positive bacteria. METHODS: A total of 379 children with sepsis were involved in this study to form the case group, and their C-reactive protein (CRP), procalcitonin (PCT) and IL-6 levels before antibiotics and after recovery were checked. Receiver operating characteristic curve was applied to evaluate the significance of CRP, PCT and IL-6 in the differential diagnosis of sepsis and their capability of differentiating the sepsis induced by Gram-negative bacteria from that induced by Gram-positive bacteria. RESULTS: When these 3 indicators were applied to the differential diagnosis of sepsis, the area under the curve (AUC) of IL-6, PCT and CRP was 0.881, 0.877 and 0.754, respectively. The combination of IL-6 and PCT presented highest diagnostic efficiency. CRP, PCT and IL-6 levels in children with sepsis induced by Gram-negative bacteria were significantly higher than those in children with sepsis induced by Gram-positive bacteria. CONCLUSIONS: CRP, IL-6 and PCT are applicable to the differential diagnosis of sepsis and differentiating the sepsis induced by Gram-negative bacteria from Gram-positive bacteria. Appropriate combinations of these indicators are capable of increasing differential diagnosis efficiency. These indicators can be used as markers of antibiotics usage, but whether they can be used as markers to withdraw antibiotics is still needed to be observed.

Draft Genome Sequence of Carbapenem-Resistant Klebsiella pneumoniae XPY20 Collected from a Bloodstream Infection Patient.

Bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) strains have been a severe problem with high clinical costs and high mortality rates. The blaKPC-2-producing CRKP strain XPY20 was collected from the blood of a patient. The genome characteristics and antimicrobial resistance mechanisms were determined using next-generation sequencing.

Simultaneous emergence and rapid spread of three OXA-23 producing Acinetobacter baumannii ST208 strains in intensive care units confirmed by whole genome sequencing.

Carbapenem-resistant Acinetobacter baumannii (CRAB) is a common nosocomial bacterial pathogen with limited treatment options. CRAB outbreaks are disastrous for critically ill patients. This study investigated carbapenemase-produced A. baumannii outbreaks in a tertiary hospital. Although multiple outbreaks were suggested by pulse-field gel electrophoresis, the genetic lineages and evolution between these isolates were not clear. To investigate the genomic epidemiology of these outbreaks and to reveal possible transmission routes, whole genome sequences (WGS) were compared and analyzed. From the WGS data, thirty isolates had the same sequence type (ST208); acquired resistance genes and chromosome resistant genes were detected and were responsible for multidrug resistance. A phylogenetic tree of single-nucleotide polymorphisms (SNPs) compared to the earliest index isolate found that three outbreaks had emerged and disseminated simultaneously. Of these, <10 SNPs were detected within the cluster, whereas at least 600 SNPs were found between the clusters. The probable transmission routes of outbreaks were generated combined with the genetic distance of isolates and patient epidemiological data. In conclusion, WGS was a convenient and accurate monitoring method for genomic epidemiologic investigation of outbreaks, and the genomic surveillance of multidrug-resistant bacterial pathogens would be a powerful warning system for the surveillance and prevention of outbreaks.

Insulin-like growth factor-1 and insulin-like growth factor-binding protein-3 concentrations in children with obstructive sleep apnea-hypopnea syndrome.

BACKGROUND: The aim of this study was to assess insulin-like growth factor-1 (IGF-1) and insulin-like growth factor-binding protein-3 (IGFBP-3) concentrations in children with obstructive sleep apnea-hypopnea syndrome (OSAHS) and to compare the results according to disease severity and duration. METHODS: Fifty-one children with OSAHS underwent polysomnography and were classified as having mild, moderate, or severe disease. All children underwent bilateral tonsillectomy/adenoidectomy or adenoidectomy. IGF-1 and IGFBP-3 concentrations were assessed before surgery and 3 and 6 months after surgery. RESULTS: Before surgery, IGF-1 and IGFBP-3 concentrations were significantly higher (P < .05) in the < 5-y group (125.20 ± 42.38 µg/L and 2.00 ± 0.54 mg/L) compared with the ≥ 5-y group (61.92 ± 19.07 µg/L and 1.20 ± 0.37 mg/L). After surgery, concentrations significantly increased (P < .05) in both groups, but remained lower in the ≥ 5-y group. Before surgery, there were no significant differences in IGF-1 (mild: 93.82 ± 37.52 mg/L; moderate: 109.06 ± 58.42 mg/L; severe: 73.88 ± 28.51 mg/L) and IGFBP-3 (mild: 1.76 ± 0.57 mg/L; moderate: 1.67 ± 0.72 mg/L; severe: 1.33 ± 0.45 mg/L) concentrations by severity. After surgery, concentrations significantly increased (P < .05) in both groups, but did not differ by severity. After adjusting for time after surgery, disease duration, apnea-hypopnea index, time spent at SpO2 < 90%, and body mass index Z score, IGF-1 and IGFBP-3 concentrations significantly decreased with every year of age. CONCLUSIONS: These results suggest that disease duration, but not severity, affects the concentrations of 2 important mediators of growth/development (IGF-1 and IGFBP-3) in children with OSAHS before and after surgery.