Can procalcitonin help identify associated bacterial infection in patients with severe influenza pneumonia? A multicentre study.

Intensive Care Med. 2011 Mar 3;

Authors: Cuquemelle E, Soulis F, Villers D, Roche-Campo F, Ara Somohano C, Fartoukh M, Kouatchet A, Mourvillier B, Dellamonica J, Picard W, Schmidt M, Boulain T, Brun-Buisson C,

PURPOSE: To determine whether procalcitonin (PCT) levels could help discriminate isolated viral from mixed (bacterial and viral) pneumonia in patients admitted to the intensive care unit (ICU) during the A/H1N1v2009 influenza pandemic. METHODS: A retrospective observational study was performed in 23 French ICUs during the 2009 H1N1 pandemic. Levels of PCT at admission were compared between patients with confirmed influenzae A pneumonia associated or not associated with a bacterial co-infection. RESULTS: Of 103 patients with confirmed A/H1N1 infection and not having received prior antibiotics, 48 (46.6%; 95% CI 37-56%) had a documented bacterial co-infection, mostly caused by Streptococcus pneumoniae (54%) or Staphylococcus aureus (31%). Fifty-two patients had PCT measured on admission, including 19 (37%) having bacterial co-infection. Median (range 25-75%) values of PCT were significantly higher in patients with bacterial co-infection: 29.5 (3.9-45.3) versus 0.5 (0.12-2) ?g/l (P < 0.01). For a cut-off of 0.8 ?g/l or more, the sensitivity and specificity of PCT for distinguishing isolated viral from mixed pneumonia were 91 and 68%, respectively. Alveolar condensation combined with a PCT level of 0.8 ?g/l or more was strongly associated with bacterial co-infection (OR 12.9, 95% CI 3.2-51.5; P < 0.001). CONCLUSIONS: PCT may help discriminate viral from mixed pneumonia during the influenza season. Levels of PCT less than 0.8 ?g/l combined with clinical judgment suggest that bacterial infection is unlikely.

PMID: 21369807 [PubMed - as supplied by publisher]

The deteriorating ward patient: a Swedish-Australian comparison.

Intensive Care Med. 2011 Mar 3;

Authors: Jäderling G, Calzavacca P, Bell M, Martling CR, Jones D, Bellomo R, Konrad D

OBJECTIVE: Most centres in Europe have not introduced a rapid response team (RRT), partly because of concerns that data from other health-care systems may not be relevant. We tested whether patient characteristics and outcomes for deteriorating patients differ between two health-care systems separated by distance and culture. METHODS: We obtained data from 3,063 RRT calls: 815 calls at Karolinska University Hospital (Sweden) and 2,248 calls at Austin Hospital (Australia) and compared demographic and clinical data, as well as outcomes for patients reviewed by a RRT. RESULTS: At Karolinska, 46.9% of patients were female compared with 45.1% at Austin. Mean age was 66.5 years versus 69.4 years. The unit of admission was surgical/medical in 49.1%/50.9% versus 48.8%/51.1% of patients, respectively. Overall, 56.7% versus 55.8% of the calls were out-of-hours (1700-0800 hours). There was a predominance of respiratory triggers at both centres and the "worried" criterion was frequently used in both hospitals (17.2% versus 14.4%) as a trigger for RRT activation. Overall, 30-day mortality was 27.7% versus 29.4% and allocation of Limitations of Medical Treatment (LOMT) orders was 34.2% versus 30.8%. The allocation of LOMT orders was influenced by the RRT in 14.4% versus 12.6% of cases. CONCLUSION: In two different health-care systems separated by geography, language, culture and organizational features, the characteristics of deteriorating ward patients, their disposal and outcomes were similar, suggesting that the care of the deteriorating ward patient is a global problem in modern hospitals and confirming that their hospital mortality is high.

PMID: 21369815 [PubMed - as supplied by publisher]