Josep Domínguez

Elevated serum procalcitonin values correlate with renal scarring in children with urinary tract infection.

Background. Urinary tract infection (UTI) in young children carries the risk of parenchymal damage and sequelae. The location of the infection within the urinary tract influences decisions regarding both therapeutics and follow-up. Because clinical features and laboratory markers of infection at an early age are not specific, it is difficult to make a distinction between lower UTI and acute pyelonephritis. Procalcitonin (PCT) has been studied as a marker of severe bacterial infection. The aim of this study was to test the usefulness of PCT concentration in serum to distinguish between uncomplicated UTI and severe acute pyelonephritis with renal scars. Methods. PCT was measured by immunoluminometric assay in serum samples from children with microbiologically documented infection. Severe renal involvement was assessed by 99mTc-dimercaptosuccinic acid gammagraphy done 5 to 6 months after the episode to check for the presence of parenchymal scars. C-reactive protein (CRP) and leukocyte count were also measured. Results. PCT at presentation showed a significant correlation (P < 0.001) with the presence of renal scars in children with UTI. Using a cutoff of 1 ng/ml for PCT and 20 mg/l for CRP, sensitivity and specificity in distinguishing between urinary tract infection with and without renal damage were 92.3 and 61.9%, respectively, for PCT and 92.3 and 34.4% for CRP. Positive and negative predictive values were 32 and 97.5%, respectively, for PCT and 23 and 95%, respectively, for CRP. Conclusions. A low PCT value at admission indicates a low risk of long term renal scarring. Increased PCT values at admission correlate with the presence of scars. PCT values have proved to be more specific than CRP and leukocyte count for identifying patients who might develop renal damage.

Evaluation of a Fluorescence Hybridisation Assay Using Peptide Nucleic Acid Probes for Identification and Differentiation of Tuberculous and Non-Tuberculous Mycobacteria in Liquid Cultures

Abstract The performance was evaluated of a fluorescence in situ hybridisation assay using peptide nucleic acid probes (Dako Probe MTB Culture Confirmation Test; Dako, Denmark) for identification of Mycobacterium tuberculosis complex (MTC) organisms and differentiation between tuberculous and non-tuberculous mycobacteria (NTM) in material taken directly from Bactec 12B (Becton Dickinson, USA) and MB/BacT (Organon Teknika, USA) bottles. The test was applied to 129 smear-positive (Ziehl-Neelsen stain) clinical specimens, 48 previously identified clinical strains of mycobacteria (12 MTC and 36 NTM), and 51 reference strains (7 MTC and 44 NTM) which were all previously inoculated into Bactec 12B and MB/BacT bottles. The sensitivity and specificity of the assay for MTC-positive cultures was 87.6% and 100%, respectively, for Bactec 12B, and 100%, respectively, for MB/BacT. The sensitivity and specificity of the assay for NTM-positive cultures was 100% for both media.

Serum Concentrations of Procalcitonin After Cardiac Surgery

Abstract  Background and Aim: Monitorization of complications in patients underlying cardiac surgery may be difficult because cardiopulmonary bypass (CPB) can lead to a systemic inflammatory response syndrome because of exposure of blood to nonphysiological surfaces. The purpose of the study was to establish the baseline levels of procalcitonin (PCT) after cardiac surgery in our population in order to analyze a possible induction of the inflammatory response that might interfere with the diagnosis of infection by PCT. Methods: Serum samples from patients undergoing coronary artery bypass grafting or valve replacement were collected at the time of admission to intensive care unit, after surgery as well as in the first and second postoperative days. Patients were followed for the development of postoperative complications. PCT levels were measured by immunoluminometric assay. Results: The mean PCT values were significantly higher in the first postoperative day in all the groups except the control group. No increased PCT levels were found related neither to duration of CPB, nor to time of aortic clamping. Only patients who presented complications had significantly increased PCT values immediately after surgery (p = 0.004), in the first postoperative day (p < 0.0001), and in the second postoperative day (p < 0.0001) with respect to those who recovered uneventfully. Conclusions: A slight and transient increase in PCT levels was observed in the first postoperative day after cardiac surgery. Significant elevation of PCT was only observed when complications were present.

Noninvasive Method for Diagnosis of Visceral Leishmaniasis by a Latex Agglutination Test for Detection of Antigens in Urine Samples

Since the appearance of human immunodeficiency virus (HIV), visceral leishmaniasis (VL) has emerged as an opportunistic infection in developed countries (1, 3, 10). It appears in advanced stages of HIV infection and is supposed to accelerate the progression of AIDS (3, 5, 8). Therapeutic failures and relapses are common. Accurate diagnosis is usually difficult in HIV-coinfected patients because VL has atypical clinical expressions and because serological diagnosis becomes unreliable (1). Demonstration of the parasite in cultured samples or in stained preparations is considered the “gold standard” (GS) for diagnosis but requires invasive techniques. A noninvasive and accurate test is needed in order to improve diagnosis of VL, especially in individuals with an increased risk of suffering complications after invasive methods (2, 6). We have evaluated the effectiveness of a rapid latex agglutination test (LAT) (KATEX; Kalon Biological Ltd., Aldershot, Hants, United Kingdom) in the detection of a leishmanial antigen (9) in urine from patients with VL and its usefulness in treatment monitoring. A bone marrow aspirate and a fresh urine specimen were collected from 85 patients with suggestive clinical symptoms and signs of VL. The demonstration of the parasite by culture or Giemsa stain in bone marrow aspirate was considered the GS. In 16 out of 89 cases the VL clinical diagnosis was confirmed by the GS (group 1), while in 73 it was not (group 2). Urine samples from 73 patients without any suspicion of VL were collected as negative controls (group 3). The percentages of HIV-infected individuals were as follows: 100% in group 1, 91% in group 2, and 21% in group 3. The LAT was performed in previously boiled urine specimens according to the manufacturers instructions. A clear agglutination was recorded as positive. All specimens from group 1, three from group 2, and none from group 3 were positive by the LAT (Table ​(Table1).1). One of the three patients from group 2 who tested positive had been diagnosed with VL 1 year before. The sensitivity was 100%, and specificity was 96% (Table ​(Table11). TABLE 1. Leishmanial urinary antigen detection in different patient groups We followed up the cases of 13 of the 16 patients from group 1. A urine specimen was collected each time they came to the hospital, and a bone marrow aspirate was also collected if a VL relapse was suspected. The LAT was performed for all urine samples obtained. The leishmanial antigen could be detected in urine up to 1 year after VL diagnosis in HIV-coinfected patients, probably due to their inability to control the parasitosis (4, 7). Therefore, this technique does not seem very helpful in monitoring treatment and predicting relapses. However, our results show that the test is a sensitive and specific noninvasive tool for diagnosing VL. It is easy to perform and interpret, so it could be used as a screening test in developing areas and among susceptible populations. However, due to the low number of patients with VL included in our evaluation, further studies are needed to confirm these data.

Centrifugal Ultrafiltration Method for Rapid Concentration of Legionella pneumophila Urinary Antigen

Detection of Legionella pneumophila antigen in urine by enzyme immunoassay (EIA) or by immunochromatographic testing (ICT) has proven rapid, sensitive, and specific for diagnosing legionellosis ([2][1], [3][2], [5][3], [6][4]). Although it requires added processing time, the use of concentrated

Lack of impact of human immunodeficiency virus infection on the outcome of lymphoma patients transferred to the intensive care unit

Abstract The impact of human immunodeficiency virus (HIV) infection on the outcome of patients with acquired immunodeficiency syndrome (AIDS)-related lymphoma with life-threatening complications requiring intensive care unit (ICU) admission is not well known. The objective of this study was to compare the outcome of patients with lymphoma transferred to the ICU according to HIV infection status. The clinical characteristics, reason for ICU admission, and outcome of 48 consecutive critically ill patients with lymphoma admitted to the ICU from January 2000 to March 2010 was retrospectively analyzed, focusing on their HIV serology status. Thirty-six patients were HIV-negative and 12 patients HIV-positive. Burkitt lymphoma was more frequent in HIV-infected patients, whereas diffuse large B-cell lymphoma was more frequent in HIV-negative patients. The main acute life-threatening diseases precipitating ICU transfer were similar in both groups. Severe neutropenia was more frequent in HIV-positive than in HIV-negative patients. With a median follow-up of 53 months after ICU admission, the overall survival probabilities were 15% (95% confidence interval [CI]: 3–27%) and 17% (95% CI: 0–38%) for HIV-negative and HIV-positive patients, respectively. The 2-year survival probabilities were 34% (95% CI: 10–58%) and 40% (95% CI: 0–43%) for HIV-negative and HIV-positive patients discharged from the ICU, respectively. In this study, HIV infection did not have a negative impact on the outcome of patients with lymphoma admitted to the ICU.

Relación entre los valores séricos de procalcitonina y las complicaciones y supervivencia de pacientes con hemopatías malignas ingresados en una Unidad de Vigilancia Intensiva

BACKGROUND AND OBJECTIVE Patients with hematological neoplasms transferred to an Intensive Care Unit (ICU) for a life-threatening complication have a poor outcome. In these patients, it is crucial to identify clinical and biologic parameters with potential prognostic significance. This study prospectively evaluated the usefulness of serum procalcitonin (PCT) levels as a predictor of complications (infectious or not) and outcome in these patients. PATIENTS AND METHOD One hundred patients with hematological malignancy were admitted to the ICU from October 2004 until August 2009. In 59 of them serum PCT levels were daily measured from the ICU admission until a maximum period of 10 consecutive days. RESULTS Hematological diseases were acute leukemia (n=30), lymphoma and other lymphoproliferative disorders (n=18), multiple myeloma (n=7) and other (n=4). Twenty-five patients (42%) had received hematopoietic stem cell transplantation. Thirty-seven patients (63%) presented neutropenia. Those patients who could not be discharged alive from the ICU presented higher PCT levels on days 1, 2 and 3. PCT levels were significantly higher in those patients with neutropenia or septic shock or other causes of hemodynamic instability. The presence of a microbiologically documented infection, respiratory failure or the need of mechanical ventilation support did not significantly affect PCT levels in this study. CONCLUSIONS Early serum PCT levels measurement might be useful for predicting mortality in patients with hematological malignancy requiring advanced life support.

Original breveRelación entre los valores séricos de procalcitonina y las complicaciones y supervivencia de pacientes con hemopatías malignas ingresados en una Unidad de Vigilancia IntensivaRelationship between procalcitonin serum levels and complications and outcome of patients with hematological malignancy admitted to Intensive Care Unit

BACKGROUND AND OBJECTIVE Patients with hematological neoplasms transferred to an Intensive Care Unit (ICU) for a life-threatening complication have a poor outcome. In these patients, it is crucial to identify clinical and biologic parameters with potential prognostic significance. This study prospectively evaluated the usefulness of serum procalcitonin (PCT) levels as a predictor of complications (infectious or not) and outcome in these patients. PATIENTS AND METHOD One hundred patients with hematological malignancy were admitted to the ICU from October 2004 until August 2009. In 59 of them serum PCT levels were daily measured from the ICU admission until a maximum period of 10 consecutive days. RESULTS Hematological diseases were acute leukemia (n=30), lymphoma and other lymphoproliferative disorders (n=18), multiple myeloma (n=7) and other (n=4). Twenty-five patients (42%) had received hematopoietic stem cell transplantation. Thirty-seven patients (63%) presented neutropenia. Those patients who could not be discharged alive from the ICU presented higher PCT levels on days 1, 2 and 3. PCT levels were significantly higher in those patients with neutropenia or septic shock or other causes of hemodynamic instability. The presence of a microbiologically documented infection, respiratory failure or the need of mechanical ventilation support did not significantly affect PCT levels in this study. CONCLUSIONS Early serum PCT levels measurement might be useful for predicting mortality in patients with hematological malignancy requiring advanced life support.

Cobertura vacunal frente a tos ferina en gestantes de Cataluña en el primer año de implantación del programa de inmunización

INTRODUCTION The re-emergence of pertussis and the severity of its complications in infants younger than 3 months, were determining factors for starting a vaccination program for pregnant women in the third trimester of gestation in Catalonia in February 2014. This was the first autonomous community to introduce it in Spain. The aim of the study was to estimate the coverage of the program in its first year of implementation. METHODS A retrospective analysis was performed on the data from the Primary Care Centre computerised medical records of pregnant women attending Sexual and Reproductive Health Care centres of the Metropolitan Nord area of the province of Barcelona, part of the Catalan Institute of Health. The overall coverage was estimated, as well as the sociodemographic variables of Tdap vaccination of women who had registered a delivery of a live birth between August 2014 and August 2015. RESULTS A total of 6,697 deliveries of live births were recorded, and 1,713 pregnant women were vaccinated, which represented an overall coverage of 25.6% (95% CI; 24.1-26.1). Vaccination coverage was higher in pregnant women under 18 years and Spanish women (P=.018 and P=.036, respectively). CONCLUSION The estimation of vaccine coverage against pertussis in pregnant women in the third trimester of pregnancy, after the first year of implementation of the program in a health area of Catalonia was lower than the objective set. Strategies need to be designed in order to improve program coverage.

Keys to success of a community of clinical practice in primary care: a qualitative evaluation of the ECOPIH project

BackgroundThe current reality of primary care (PC) makes it essential to have telemedicine systems available to facilitate communication between care levels. Communities of practice have great potential in terms of care and education, and that is why the Online Communication Tool between Primary and Hospital Care was created. This tool enables PC and non-GP specialist care (SC) professionals to raise clinical cases for consultation and to share information. The objective of this article is to explore healthcare professionals’ views on communities of clinical practice (CoCPs) and the changes that need to be made in an uncontrolled real-life setting after more than two years of use.MethodsA descriptive-interpretative qualitative study was conducted on a total of 29 healthcare professionals who were users and non-users of a CoCP using 2 focus groups, 3 triangular groups and 5 individual interviews. There were 18 women, 21 physicians and 8 nurses. Of the interviewees, 21 were PC professionals, 24 were users of a CoCP and 7 held managerial positions.ResultsFor a system of communication between PC and SC to become a tool that is habitually used and very useful, the interviewees considered that it would have to be able to find quick, effective solutions to the queries raised, based on up-to-date information that is directly applicable to daily clinical practice. Contact should be virtual – and probably collaborative – via a platform integrated into their habitual workstations and led by PC professionals. Organisational changes should be implemented to enable users to have more time in their working day to spend on the tool, and professionals should have a proactive attitude in order to make the most if its potential. It is also important to make certain technological changes, basically aimed at improving the tool’s accessibility, by integrating it into habitual clinical workstations.ConclusionsThe collaborative tool that provides reliable, up-to-date information that is highly transferrable to clinical practice is valued for its effectiveness, efficiency and educational capacity. In order to make the most of its potential in terms of care and education, organisational changes and techniques are required to foster greater use.