Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

AGUSTÍN JULIÁN-JIMÉNEZ, DARÍO EDUARDO GARCÍA, GRACIELA MERINOS-SÁNCHEZ, LUIS GARCÍA DE GUADIANA-ROMUALDO, JUAN GONZÁLEZ DEL CASTILLO

Published: 7 December 2023

http://www.doi.org/10.37201/req/099.2023

Introduction. Obtaining blood cultures (HC) is performed in 15% of the patients treated with suspicion of infection in the Hospital Emergency Services (ED) with a variable diagnostic yield (2-20%). The 30-day mortality of patients with bacteremia is two or three times higher than the rest with the same process. Procalcitonin (PCT) is a biomarker that has been used as a tool to help predict bacteremia in HEDs. The main objective of this systematic review is to investigate the diagnostic accuracy of PCT in predicting true bacteraemia in adult patients treated with clinical suspicion of infection in the ED, as well as to identify a specific PCT value as the most relevant from the clinical decision diagnostic point of view that can be recommended for decision making

Method. A systematic review was performed following the PRISMA guidelines in the PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov databases from January 2010 to May 31, 2023 without language restrictions and using a combination of MESH terms: “Bacteremia/ Bacteraemia/ Blood Stream Infection”, “Procalcitonin”, “Emergencies/ Emergency/ Emergency Department” and “Adults”. Observational cohort studies and partially an systematic review were included. No meta-analysis techniques were performed, but the results were compared narratively.
Results. A total of 1,372 articles were identified, of which 20 that met the inclusion criteria were finally analyzed. The included studies represent a total of 18,120 processed HC with 2,877 bacteraemias (15.88%). Ten studies were rated as high, 9 moderate and 1 low quality. The AUC-COR of all the studies ranges from 0.68 (95% CI: 0.59-0.77) to 0.98 (95% CI: 0.97-0.99). The PCT value >0.5 ng/ml is the most widely used and proposed in up to ten of the works included in this systematic review, whose estimated mean yield is an AUC-COR of 0.833. If only the results of the 6 high-quality studies using a cut-off point (PC) >0.5 ng/mL PCT are taken into account, the estimated mean AUC-COR result is 0.89 with Se of 77.6% and It is 78%.
Conclusions. PCT has a considerable diagnostic accuracy of bacteraemia in patients treated in EDs for different infectious processes. The CP>0.5 ng/ml has been positioned as the most suitable for predicting the existence of bacteraemia and can be used to reasonably rule it out.

Rev Esp Quimioter 2024; 37(1): 29-42 [Texto completo PDF]

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Efficacy and safety of pediatric flu vaccination: a systematic review

FRANCISCO MIGUEL ESCANDELL RICO, LUCIA PÉREZ FERNÁNDEZ

Published: 5 December 2023

http://www.doi.org/10.37201/req/101.2023

Introduction. Children are at a higher risk of influenza infection compared to the general population. The World Organization Health and recommendations of the Vaccine Advisory Committee of the Spanish Association of Pediatrics contemplate annual vaccination as the most effective way to prevent the disease. Therefore, the purpose of this review was to update information on efficacy and safety in the anti -shed vaccine in children and adolescents.
Material and methods. A search in four electronic databases (Scopus, Cumulative Index to Nursing and Allied Health Literature, Medline / Pubmed, Google Scholar and Cochrane), as well as a manual search to identify original research published between 2012 and 2022. The guidelines of ANALYSIS (PRISMACR) as a preferred report element for systematic reviews.
Results. Seven original research articles were included where two issues of antigripal vaccination were identified in healthy children/adolescents and with pathologies. The efficacy (between approximately 30% and 80%) varied depending on the vaccine used and circulating subtypes. Most adverse reactions were mild intensity, and the most common local adverse event was pain in the injection site.
Conclusions. We positively highlight the safety of pediatric flu vaccination in analyzed studies, on the contrary, with respect to the efficacy of flu vaccination, we observe a wide variability of results. There is a clear need to continue conducting efficacy and safety studies in the child.

Rev Esp Quimioter 2024;37(1): 43-51 [Texto completo PDF]

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The Magnificent Seven: Seven good publications in infectious diseases

OLGA ALGARA, LAURA EVA FRANCO, JUAN MANUEL GARCÍA-LECHUZ

Published: 24 November 2023

http://www.doi.org/10.37201/req/s01.16.2023

ABSTRACT
The world of infectious diseases, for various reasons, before and after the COVID-19 pandemic, capture the attention of the scientific community, either due to the epidemiological data of various microbial agents that are emerging, due to the implementation with successful results of new diagnostic strategies or due to the appearance of new therapeutic options, which encourage healthcare workers to continue on the front line.
Topics such as antimicrobial resistance, S. aureus bacteremia, clostridioides difficile, short treatments for tuberculosis, prosthetic joint infection or invasive fungal infections are included. In this article, we want to highlight, among many others, seven recently published articles that deserve our attention, full of useful information to keep us updated.

Rev Esp Quimioter 2023; 36(Suppl.1):68-70 [Full-text PDF]

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New trends in antifungal treatment: What is coming up?

JESÚS GUINEA

Published: 24 November 2023

http://www.doi.org/10.37201/req/s01.14.2023

ABSTRACT
New antifungal agents are needed to overcome limitations of available ones such as poor pharmacokinetic traits, toxicity, drug-drug interactions, limited clinical efficacy, and emerging antifungal resistance. New antifungal drugs belong to well-known families (azoles, polyenes, or beta-d-glucan synthase inhibitors) or to drug families showing completely new mechanisms of action. Some drugs have a head start in terms of potential to reach the clinical setting and are here reviewed.

Rev Esp Quimioter 2023; 36(Suppl.1):59-63 [Full-text PDF]

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Post-CART-T Cell Infection: Etiology, pathogenesis, and therapeutic approaches

NICOL GARCÍA-POUTÓN, OLIVER PEYRONY, MARIANA CHUMBITA, FRANCESCO AIELLO, PATRICIA MONZO, ANTONIO GALLARDO-PIZARRO, CAROLINA GARCIA-VIDAL

Published: 24 November 2023

http://www.doi.org/10.37201/req/s01.12.2023

ABSTRACT
Chimeric antigen receptor (CAR) T cell therapy targeting CD-19 has revolutionized the treatment of refractory B-cell malignancies. However, patients undergoing this therapy face an increased risk of infections due to compromised immune function, lymphodepleting chemotherapy, hospitalization, and therapy-related complications such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome. Patients with systemic corticosteroid use, low immunoglobulin levels, and severe CRS, are at higher risk of infection. This review article highlights the spectrum of infections encountered in CAR T cell therapy, including bacterial, viral, and fungal infections. Following consensus guidelines for vaccination and immunoglobulin replacement is recommended. Clear criteria for antibiotic usage and vaccinating household members against respiratory viruses are crucial. Understanding the risk factors, spectrum of infections, and implementing appropriate prophylactic measures are essential to optimize outcomes in patients undergoing CAR T cell therapy. By prioritizing infection prevention strategies, healthcare professionals can effectively improve patient care.

Rev Esp Quimioter 2023; 36(Suppl.1):52-53 [Full-text PDF]

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