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Apoorva S, Nguyen NT, Sreejith KR. Recent developments and future perspectives of microfluidics and smart technologies in wearable devices. LAB ON A CHIP 2024; 24:1833-1866. [PMID: 38476112 DOI: 10.1039/d4lc00089g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Wearable devices are gaining popularity in the fields of health monitoring, diagnosis, and drug delivery. Recent advances in wearable technology have enabled real-time analysis of biofluids such as sweat, interstitial fluid, tears, saliva, wound fluid, and urine. The integration of microfluidics and emerging smart technologies, such as artificial intelligence (AI), machine learning (ML), and Internet of Things (IoT), into wearable devices offers great potential for accurate and non-invasive monitoring and diagnosis. This paper provides an overview of current trends and developments in microfluidics and smart technologies in wearable devices for analyzing body fluids. The paper discusses common microfluidic technologies in wearable devices and the challenges associated with analyzing each type of biofluid. The paper emphasizes the importance of combining smart technologies with microfluidics in wearable devices, and how they can aid diagnosis and therapy. Finally, the paper covers recent applications, trends, and future developments in the context of intelligent microfluidic wearable devices.
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Affiliation(s)
- Sasikala Apoorva
- UKF Centre for Advanced Research and Skill Development(UCARS), UKF College of Engineering and Technology, Kollam, Kerala, India, 691 302
| | - Nam-Trung Nguyen
- Queensland Micro and Nanotechnology Centre, Griffith University, 170 Kessels Road, Nathan, 4111, Queensland, Australia.
| | - Kamalalayam Rajan Sreejith
- Queensland Micro and Nanotechnology Centre, Griffith University, 170 Kessels Road, Nathan, 4111, Queensland, Australia.
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Grey B, Upton M, Joshi LT. Urinary tract infections: a review of the current diagnostics landscape. J Med Microbiol 2023; 72. [PMID: 37966174 DOI: 10.1099/jmm.0.001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Urinary tract infections are the most common bacterial infections worldwide. Infections can range from mild, recurrent (rUTI) to complicated (cUTIs), and are predominantly caused by uropathogenic Escherichia coli (UPEC). Antibiotic therapy is important to tackle infection; however, with the continued emergence of antibiotic resistance there is an urgent need to monitor the use of effective antibiotics through better stewardship measures. Currently, clinical diagnosis of UTIs relies on empiric methods supported by laboratory testing including cellular analysis (of both human and bacterial cells), dipstick analysis and phenotypic culture. Therefore, development of novel, sensitive and specific diagnostics is an important means to rationalise antibiotic therapy in patients. This review discusses the current diagnostic landscape and highlights promising novel diagnostic technologies in development that could aid in treatment and management of antibiotic-resistant UTIs.
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Affiliation(s)
- Braith Grey
- Peninsula Dental School, Faculty of Health, University of Plymouth, Plymouth, Devon, UK
| | - Mathew Upton
- School of Biomedical Sciences, Faculty of Health, University of Plymouth, Plymouth, Devon, UK
| | - Lovleen Tina Joshi
- Peninsula Dental School, Faculty of Health, University of Plymouth, Plymouth, Devon, UK
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Yankov YG, Bocheva Y. Comparative Characterization of Procalcitonin (Sensitivity, Specificity, Predictability, and Cut-Off Reference Values) as a Marker of Inflammation in Odontogenic Abscesses of the Head and Neck in the Female Population. Cureus 2023; 15:e48207. [PMID: 38050495 PMCID: PMC10693721 DOI: 10.7759/cureus.48207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Introduction Odontogenic abscesses of the head and neck can lead to serious complications and even end in death. This requires healthcare professionals to have a good knowledge of all the markers of inflammation that can be used in their diagnosis and treatment. Such markers that we use in our daily medical practice are leukocytes (WBC), neutrophils (Neu), and C-reactive protein (CRP). Somehow, in the background is procalcitonin (PCT), which has not been studied in detail in this type of purulent infection. The aim of the present study is to investigate and analyze PCT in odontogenic purulent infections of the head and neck in the female population and to compare it with already proven markers of inflammation such as CRP, WBC, and Neu. For the first time in the literature, as per our knowledge, the sensitivity, specificity, and predictability of PCT were determined when using it as an independent indicator of inflammation, and its cut-off reference values were determined in women with odontogenic abscesses of the head and neck. Materials and methods This is a prospective study, in which the CRP, WBC, Neu, and PCT of 30 women with odontogenic abscesses of the head and neck with a mean age of 47 (18-81) years were examined and analyzed. As a control group, we included 30 healthy women with a mean age of 48 (18-80) years, in whom there was no anamnestic and physical evidence of the presence of any infection in the last three months. The four markers were measured for the control group too. Results In the clinical group of women with odontogenic abscesses of the head and neck, the average values of CRP, WBC, Neu, and PCT were significantly higher (p<0.0001) compared to the same in the control group of healthy women; CRP: 95.46±76.41 mg/l vs. 0.63±0.37 mg/l, WBC: 10.44±2.97x103/L vs. 6.5±1.49x103/L, Neu: 7.92±2.93x103/L vs. 4.03±1.07x103/L, PCT: 0.74±0.69 ng/ml vs. 0.14±0.08 ng/ml. Discussion PCT, as well as CRP, WBC, and Neu, increases its plasma concentration in women with odontogenic abscesses of the head and neck and is extremely well positively correlated with them, with a high correlation with CRP and a significant correlation with WBC and Neu. In addition, PCT has a number of advantages over the other markers; it begins to increase its plasma concentration faster, reaches its maximum plasma concentration faster, normalizes its concentration faster after the infection subsides, and increases its blood level only in bacterial infection genesis. Conclusions PCT as a marker of inflammation not only positively correlates well with CRP, WBC, and Neu but also, with its advantages over them, it appears to be the most accurate indicator in the diagnosis, treatment, and follow-up of odontogenic head and neck abscesses in the near future; not only in women but also in the male and children's population. Its sensitivity, specificity, and predictability as an independent indicator of inflammation are 80%, 76.7%, and 83%, respectively, and its cut-off value of 0.225 ng/ml is lower than the generally accepted 0.5 ng/ml.
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Affiliation(s)
- Yanko G Yankov
- Maxillofacial Surgery, University Hospital St. Marina, Varna, BGR
- General and Operative Surgery, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, BGR
| | - Yana Bocheva
- Cinical Laboratory, Medical University "Prof. Dr. Paraskev Stoyanov", Varna, BGR
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Elgormus Y, Okuyan O, Dumur S, Sayili U, Uzun H. Evaluation of new generation systemic immune-inflammation markers to predict urine culture growth in urinary tract infection in children. Front Pediatr 2023; 11:1201368. [PMID: 37920790 PMCID: PMC10618680 DOI: 10.3389/fped.2023.1201368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/25/2023] [Indexed: 11/04/2023] Open
Abstract
Objective Systemic inflammation has been implicated in the development and progression of urinary tract infection (UTI). Accordingly, the aim of this study is to determine whether the white blood cell (WBC), C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) are useful markers to predict of urine culture growth in children with UTI. The second aim of this study is to evaluate the prevalence of UTI pathogens, antibiotic resistance patterns, and empirical treatment options in children diagnosed with UTI based on laboratory and clinical findings. Method The study population comprised 413 cases (positive urine culture) and 318 cases (negative urine culture) of pediatric patients with UTI. Results There was no statistically significant difference observed in the median levels of hemoglobin, hematocrit, and platelet between the negative and positive culture groups. The median levels of monocytes, WBC, NLR, SII, and CRP of the patients with a positive urine culture were shown to be statistically significantly higher than the patients with a negative urine culture. The AUC value was 0.747 (0.710-0.784) for CRP with a cutoff value of 3.2, the sensitivity value was 56.4%, and the specificity value was 98.4% in terms of UTI. The AUC value was 0.733 (0.697-0.769) for SII with a cutoff value of 600, the sensitivity value was 58.4%, and the specificity value was 83.0%. The AUC value was 0.732 (0.697-0.769) for NLR with a cutoff value of 2, the sensitivity value was 57.4%, and the specificity value was 81.1%. Conclusion WBC, CRP, NLR, PLR, and SII could potentially serve as useful independent diagnostic or complementary markers for disease in children diagnosed with UTI who exhibit a positive urine culture. Escherichia coli was found to be the most common causative agent, and the commonly prescribed antibiotic was cephalosporin. However, it was observed that all identified agents of pediatric UTIs in our center exhibited high resistance to cefuroxime, trimethoprim-sulfamethoxazole, cefixime, ampicillin, and ceftriaxone.
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Affiliation(s)
- Yusuf Elgormus
- Clinic of Pediatrics, Medicine Hospital, İstanbul, Türkiye
| | - Omer Okuyan
- Department of Pediatrics, Medicine Hospital, Istanbul Atlas University, Istanbul, Türkiye
| | - Seyma Dumur
- Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, Istanbul, Türkiye
| | - Ugurcan Sayili
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Hafize Uzun
- Department of Medical Biochemistry, Faculty of Medicine, Istanbul Atlas University, Istanbul, Türkiye
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Shi J, Zhan ZS, Zheng ZS, Zhu XX, Zhou XY, Zhang SY. Correlation of procalcitonin and c-reactive protein levels with pathogen distribution and infection localization in urinary tract infections. Sci Rep 2023; 13:17164. [PMID: 37821527 PMCID: PMC10567997 DOI: 10.1038/s41598-023-44451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/09/2023] [Indexed: 10/13/2023] Open
Abstract
Aimed to explore the relationships between infection localization, bacterial species, and procalcitonin (PCT) and C-reactive protein (CRP) levels in urinary tract infections (UTIs). A retrospective study included 314 UTI hospitalized patients divided into two groups (268 with lower UTI, 46 with upper UTI) in a tertiary care hospital. PCT and CRP were performed. Bacterial isolates were identified using standard microbiological techniques, and statistical analyses were performed to assess associations between infection localization, bacterial species, PCT, and CRP levels. Age and gender showed no significant differences between the lower and upper UTIs. Escherichia coli dominated as the leading UTI pathogen. A positive correlation (r = 0.646, P < 0.001) between PCT and CRP levels was found. The subgroup with ureteritis in the upper UTI category exhibited the highest PCT and CRP levels. PCT and CRP exhibited favorable diagnostic potential in predicting upper UTIs, with AUCs of 0.644 and 0.629, respectively. The optimal cutoff values were 0.21 ng/mL for PCT and 60.77 mg/L for CRP. Sensitivities were 69.03% and 77.99%, while specificities were 56.52% and 47.83%, respectively. E. coli emerged as the predominant bacterium in UTIs. PCT and CRP demonstrated moderate diagnostic efficacy in distinguishing between upper and lower UTIs. Notably, PCT and CRP exhibited enhanced utility in identifying ureteritis.
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Affiliation(s)
- Jing Shi
- Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, 355200, Fujian, China
| | - Zhi-Song Zhan
- Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, 355200, Fujian, China
| | - Zu-Shun Zheng
- Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, 355200, Fujian, China
| | - Xue-Xia Zhu
- Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, 355200, Fujian, China
| | - Xin-Yi Zhou
- Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, 355200, Fujian, China
| | - Shi-Yan Zhang
- Fuding Hospital, Fujian University of Traditional Chinese Medicine, Fuding, 355200, Fujian, China.
- Department of Clinical Laboratory, Fuding Hospital, Fujian University of Traditional Chinese Medicine, 120 South Road of Old City, Fuding, China.
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Mouliou DS. C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians. Diseases 2023; 11:132. [PMID: 37873776 PMCID: PMC10594506 DOI: 10.3390/diseases11040132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
The current literature provides a body of evidence on C-Reactive Protein (CRP) and its potential role in inflammation. However, most pieces of evidence are sparse and controversial. This critical state-of-the-art monography provides all the crucial data on the potential biochemical properties of the protein, along with further evidence on its potential pathobiology, both for its pentameric and monomeric forms, including information for its ligands as well as the possible function of autoantibodies against the protein. Furthermore, the current evidence on its potential utility as a biomarker of various diseases is presented, of all cardiovascular, respiratory, hepatobiliary, gastrointestinal, pancreatic, renal, gynecological, andrological, dental, oral, otorhinolaryngological, ophthalmological, dermatological, musculoskeletal, neurological, mental, splenic, thyroid conditions, as well as infections, autoimmune-supposed conditions and neoplasms, including other possible factors that have been linked with elevated concentrations of that protein. Moreover, data on molecular diagnostics on CRP are discussed, and possible etiologies of false test results are highlighted. Additionally, this review evaluates all current pieces of evidence on CRP and systemic inflammation, and highlights future goals. Finally, a novel diagnostic algorithm to carefully assess the CRP level for a precise diagnosis of a medical condition is illustrated.
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Choi JJ, McCarthy MW, Meltzer KK, Cornelius-Schecter A, Jabri A, Reshetnyak E, Banerjee S, Westblade LF, Mehta S, Simon MS, Zhao Z, Glesby MJ. The Diagnostic Accuracy Of Procalcitonin for Urinary Tract Infection in Hospitalized Older Adults: a Prospective Study. J Gen Intern Med 2022; 37:3663-3669. [PMID: 34997392 PMCID: PMC8741546 DOI: 10.1007/s11606-021-07265-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The diagnosis of urinary tract infection (UTI) is challenging among hospitalized older adults, particularly among those with altered mental status. OBJECTIVE To determine the diagnostic accuracy of procalcitonin (PCT) for UTI in hospitalized older adults. DESIGN We performed a prospective cohort study of older adults (≥65 years old) admitted to a single hospital with evidence of pyuria on urinalysis. PCT was tested on initial blood samples. The reference standard was a clinical definition that included the presence of a positive urine culture and any symptom or sign of infection referable to the genitourinary tract. We also surveyed the treating physicians for their clinical judgment and performed expert adjudication of cases for the determination of UTI. PARTICIPANTS Two hundred twenty-nine study participants at a major academic medical center. MAIN MEASURES We calculated the area under the receiver operating characteristic curve (AUC) of PCT for the diagnosis of UTI. KEY RESULTS In this study cohort, 61 (27%) participants met clinical criteria for UTI. The median age of the overall cohort was 82.6 (IQR 74.9-89.7) years. The AUC of PCT for the diagnosis of UTI was 0.56 (95% CI, 0.46-0.65). A series of sensitivity analyses on UTI definition, which included using a decreased threshold for bacteriuria, the treating physicians' clinical judgment, and independent infectious disease specialist adjudication, confirmed the negative result. CONCLUSIONS Our findings demonstrate that PCT has limited value in the diagnosis of UTI among hospitalized older adults. Clinicians should be cautious using PCT for the diagnosis of UTI in hospitalized older adults.
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Affiliation(s)
- Justin J Choi
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-355, New York, NY, 10021, USA.
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.
| | - Matthew W McCarthy
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-355, New York, NY, 10021, USA
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Kerry K Meltzer
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | | | - Assem Jabri
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-355, New York, NY, 10021, USA
| | - Evgeniya Reshetnyak
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, LH-355, New York, NY, 10021, USA
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Lars F Westblade
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Saurabh Mehta
- Institute for Nutritional Sciences, Global Health, and Technology, Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Matthew S Simon
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Zhen Zhao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Marshall J Glesby
- NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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A diagnostic platform for rapid, simultaneous quantification of procalcitonin and C-reactive protein in human serum. EBioMedicine 2022; 76:103867. [PMID: 35149284 PMCID: PMC8841998 DOI: 10.1016/j.ebiom.2022.103867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 01/08/2023] Open
Abstract
Background Early and accurate determination of bacterial infections as a potential cause for a patient's systemic inflammatory response is required for timely administration of appropriate treatment and antibiotic stewardship. Procalcitonin (PCT) and C-reactive protein (CRP) have both been used as biomarkers to infer bacterial infections, particularly in the context of sepsis. There is an urgent need to develop a platform for simultaneous quantification of PCT and CRP, to enable the potential use of these biomarkers at the point-of-care. Methods A multiplexed lateral flow assay (LFA) and a fluorescence optical reader were developed. Assay performance was validated by testing spiked antigens in the buffer, followed by a validation study comparing results with conventional assays (Roche Cobas e411 Elecsys PCT and Siemens ADVIA XPT CRP) in 25 archived remnant human serum samples. Findings A linear regression correlation of 0·97 (P < 0·01) was observed for PCT, and a correlation of 0·95 (P < 0·01) was observed for CRP using direct patient samples. We also validated our platform's ability to accurately quantify high-dose CRP in the hook effect range where excess unlabeled analytes occupy binding sites at test lines. Interpretation A fluorescence reader-based duplex LFA for simultaneous quantification of PCT and CRP was developed and successfully validated with clinical samples. The rapid, portable, and low-cost nature of the platform offers potential for differentiation of bacterial and viral infections in emergency and low-resource settings at the point-of-care. Funding NIH/NIBIB Award 1R01EB021331, and Academic Venture Fund from the Atkinson Center for a Sustainable Future at Cornell University.
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Erdoğan S, Sürmeli Döven S. Evaluation of platelet indices in children with renal scarring based on diagnostic accuracy criteria and Cohen's kappa. Pediatr Int 2022; 64:e15055. [PMID: 34773425 DOI: 10.1111/ped.15055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 10/04/2021] [Accepted: 11/11/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Renal scarring is a significant complication in recurrent urinary tract infections (UTIs) in children that can lead to hypertension and end-stage renal disease. The present study evaluates whether platelet indices may be predictive of renal scarring. METHODS Sixty-nine patients aged 1-18 years with recurrent UTIs, whose medical records were reviewed to collect data on the presence of upper/lower UTIs and the results of scintigraphic investigations with 99m-technetium dimercaptosuccinic acid, were included in the study. The platelet, platelet indices (mean platelet volume [MPV]), platelet distribution width, plateletcrit, and C-reactive protein (CRP) values of the patients during UTI episodes were reviewed retrospectively. RESULTS Mean platelet volume and CRP values were higher in the renal scarring group than in the non-renal scarring group (P < 0.001 and P = 0.003, respectively). Increases in MPV and CRP values were independent risk factors for renal scarring (OR = 5.781 [1.431-23.347] and OR = 1.922 [1.77-3.141], respectively). The sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratio values of MPV at a cut-off of >8.2 fL for renal scarring discrimination were 62.5%, 88.89%, 75.00%, 81.63%, and 13.33 [1.35-3.83], respectively. The sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratio values of CRP at a cut-off of 1.97 mg/L for renal scarring were 58.33%, 91.11%, 77.78%, 80.39%, and 14.35 [1.36-3.97], respectively. CONCLUSION Both MPV and CRP can be used as predictive markers for renal scarring. While MPV had higher sensitivity, CRP had a higher specificity and diagnostic odds ratio in predicting renal scarring.
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Affiliation(s)
- Semra Erdoğan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Serra Sürmeli Döven
- Department of Pediatric Nephrology, Faculty of Medicine, Mersin University, Mersin, Turkey
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Werbel K, Jankowska D, Wasilewska A, Taranta-Janusz K. Clinical and Epidemiological Analysis of Children's Urinary Tract Infections in Accordance with Antibiotic Resistance Patterns of Pathogens. J Clin Med 2021; 10:jcm10225260. [PMID: 34830542 PMCID: PMC8619446 DOI: 10.3390/jcm10225260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/03/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
The study was conducted to analyze urinary tract infections (UTI) in children by considering epidemiology and antibiotic resistance patterns of pathogens in accordance with inflammatory parameters. The research included 525 patients who demonstrated 627 episodes of UTI. The increasing resistance of bacteria was observed over the years covered by the study (p < 0.001). There was a significant increase of resistance to amoxicillin with clavulanic acid (p = 0.001), gentamicin (p = 0.017) and ceftazidime (p = 0.0005). According to the CART method, we managed to estimate C-reactive protein (CRP), procalcitonin (PCT) and white blood cell (WBC) values, in which antibiotic sensitivity was observed. In children with CRP > 97.91 mg/L, there was a high percentage of sensitive cases to amoxicillin with clavulanic acid (87.5%). Values of WBC above 14.45 K/µL were associated with E. coli more sensitivity to ampicillin. 100% of children with CRP > 0.42 mg/L and PCT ≤ 6.92 ng/mL had confirmed sensitivity to cefuroxime. Concerning sensitivity to gentamicin, the most optimal cut-off point of WBC was >7.80 K/µL, while in the case of nitrofurantoin, it was CRP value > 0.11 mg/L (which was presented in 98.50% of children). These results may guide us with antibiotic therapy and help to inhibit increasing antibiotic resistance.
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Affiliation(s)
- Katarzyna Werbel
- Department of Pediatrics and Nephrology, Medical University of Białystok, 15-274 Białystok, Poland; (K.W.); (A.W.)
| | - Dorota Jankowska
- Department of Statistics and Medical Informatics, Medical University of Białystok, 15-295 Białystok, Poland;
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Białystok, 15-274 Białystok, Poland; (K.W.); (A.W.)
| | - Katarzyna Taranta-Janusz
- Department of Pediatrics and Nephrology, Medical University of Białystok, 15-274 Białystok, Poland; (K.W.); (A.W.)
- Correspondence: ; Tel.: +48-85-745-06-51; Fax: +48-85-742-18-38
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Tan YRL, Chow CTC, Ganesan I, Leow HME. Hydrocele in a case of atypical Kawasaki disease: case report and review of diagnostic criteria. BMC Pediatr 2021; 21:279. [PMID: 34130639 PMCID: PMC8204479 DOI: 10.1186/s12887-021-02758-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/06/2021] [Indexed: 11/12/2022] Open
Abstract
Background Kawasaki Disease (KD) is a self-limiting vasculitis of unknown etiology. Although there are well-recognized clinical features associated with classic KD, there have been increasing numbers of atypical clinical presentations with increased dependence on the American Heart Association diagnostic algorithm for incomplete KD. Case presentation We report on a child who was initially treated for Escherichia coli left pyelonephritis and Influenza A and Rhinovirus / Enterovirus upper respiratory tract infection. The child developed an acute hydrocele and a maculopapular rash during the illness course, which prompted further evaluation for concomitant atypical KD, although there were no other physical signs suggestive of classic KD at the time. Subsequent diagnosis of atypical KD was made with confirmation on echocardiography, with timely administration of intravenous immunoglobulin. Conclusions Although there are well recognized clinical features associated with classic Kawasaki Disease, there have been increasing numbers of atypical clinical presentations with increased dependence on the American Heart Association diagnostic algorithm for incomplete Kawasaki Disease. This case report highlights the importance of considering a diagnosis of KD in a child with prolonged fever and unexplainable symptoms suggestive of inflammation, in this case, the rare presentation of an acute hydrocele. We recommend that for any child with prolonged unexplained fever, Kawasaki Disease should be considered. Trial registration Not applicable.
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Affiliation(s)
- Y R L Tan
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
| | - C-T C Chow
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - I Ganesan
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - H M E Leow
- Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
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Anfigeno L, Sertorio F, Basso L, Fontana A, Bodria M, Pistorio A, Ghiggeri GM, Damasio MB. Diffusion-Weighted MRI in the Evaluation of Renal Parenchymal Involvement during Febrile Urinary Tract Infections in Children: Preliminary Data. J Clin Med 2021; 10:jcm10112239. [PMID: 34064114 PMCID: PMC8196731 DOI: 10.3390/jcm10112239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/03/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Urinary tract infection (UTI) is the most common infection in pediatric-age patients. Acute pyelonephritis (PNA) represents a worrying situation in pediatric patients due to the risk of sepsis and long-term cicatricial consequences. The purpose of this retrospective study is to evaluate the diagnostic role of DW-MRI in relation to clinical data, to understand if there are any clinical parameters useful in identifying which patients should undergo it. Methods: According to inclusion and exclusion criteria, we enrolled 51 patients ≤15 years old admitted to our Institute between September 2012 and April 2020 with a febrile UTI who underwent DW-MRI evaluation. Clinical, laboratory and imaging data were collected. Statistical analysis was performed. Results: 34 of 51 patients with an fUTI (66.7%) showed signs of acute parenchymal involvement at DW-MRI evaluation. In 27 of these 34 (79.4%), DW-MRI showed multiple areas of pyelonephritis. A statistically significant relationship (p = 0.0004) between older age at admission and pyelonephritis was demonstrated. No statistically significant relationship was found between the other clinical, anamnestic and laboratory parameters and the outcome of DWI. Only two ultrasound examinations allowed the identification of pathological areas on the renal parenchyma. Conclusions: From these preliminary investigations, we can say that selecting the patients with fUTI on whom to perform a DW-MRI is difficult. Nevertheless, thanks to the low cost, the very rare need for sedation and the accuracy in identifying pyelonephritic areas, the use of DW-MRI in patients with febrile UTI seems recommendable.
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Affiliation(s)
- Lorenzo Anfigeno
- Department of Health Sciences (DISSAL), Università degli Studi di Genova, 16132 Genova, Italy
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
- Correspondence:
| | - Fiammetta Sertorio
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
| | - Luca Basso
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
| | - Andrea Fontana
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Monica Bodria
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
| | - Angela Pistorio
- Epidemiology and Biostatistics Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy;
| | - Gian Marco Ghiggeri
- Nephrology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy;
| | - Maria Beatrice Damasio
- Radiology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Giannina Gaslini, 16147 Genova, Italy; (F.S.); (L.B.); (M.B.); (M.B.D.)
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Diffusion-Weighted MRI in the Evaluation of Renal Parenchymal Involvement during Febrile Urinary Tract Infections in Children: Preliminary Data. J Clin Med 2021. [DOI: 10.3390/jcm10112239
expr 943224684 + 995609622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background: Urinary tract infection (UTI) is the most common infection in pediatric-age patients. Acute pyelonephritis (PNA) represents a worrying situation in pediatric patients due to the risk of sepsis and long-term cicatricial consequences. The purpose of this retrospective study is to evaluate the diagnostic role of DW-MRI in relation to clinical data, to understand if there are any clinical parameters useful in identifying which patients should undergo it. Methods: According to inclusion and exclusion criteria, we enrolled 51 patients ≤15 years old admitted to our Institute between September 2012 and April 2020 with a febrile UTI who underwent DW-MRI evaluation. Clinical, laboratory and imaging data were collected. Statistical analysis was performed. Results: 34 of 51 patients with an fUTI (66.7%) showed signs of acute parenchymal involvement at DW-MRI evaluation. In 27 of these 34 (79.4%), DW-MRI showed multiple areas of pyelonephritis. A statistically significant relationship (p = 0.0004) between older age at admission and pyelonephritis was demonstrated. No statistically significant relationship was found between the other clinical, anamnestic and laboratory parameters and the outcome of DWI. Only two ultrasound examinations allowed the identification of pathological areas on the renal parenchyma. Conclusions: From these preliminary investigations, we can say that selecting the patients with fUTI on whom to perform a DW-MRI is difficult. Nevertheless, thanks to the low cost, the very rare need for sedation and the accuracy in identifying pyelonephritic areas, the use of DW-MRI in patients with febrile UTI seems recommendable.
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Liu H, Wang X, Tang K, Peng E, Xia D, Chen Z. Machine learning-assisted decision-support models to better predict patients with calculous pyonephrosis. Transl Androl Urol 2021; 10:710-723. [PMID: 33718073 PMCID: PMC7947454 DOI: 10.21037/tau-20-1208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background To develop a machine learning (ML)-assisted model capable of accurately identifying patients with calculous pyonephrosis before making treatment decisions by integrating multiple clinical characteristics. Methods We retrospectively collected data from patients with obstructed hydronephrosis who underwent retrograde ureteral stent insertion, percutaneous nephrostomy (PCN), or percutaneous nephrolithotomy (PCNL). The study cohort was divided into training and testing datasets in a 70:30 ratio for further analysis. We developed 5 ML-assisted models from 22 clinical features using logistic regression (LR), LR optimized by least absolute shrinkage and selection operator (Lasso) regularization (Lasso-LR), support vector machine (SVM), extreme gradient boosting (XGBoost), and random forest (RF). The area under the curve (AUC) was applied to determine the model with the highest discrimination. Decision curve analysis (DCA) was used to investigate the clinical net benefit associated with using the predictive models. Results A total of 322 patients were included, with 225 patients in the training dataset, and 97 patients in the testing dataset. The XGBoost model showed good discrimination with the AUC, accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.981, 0.991, 0.962, 1.000, 1.000, and 0.989, respectively, followed by SVM [AUC =0.985, 95% confidence interval (CI): 0.970–1.000], Lasso-LR (AUC =0.977, 95% CI: 0.958–0.996), LR (AUC =0.936, 95% CI: 0.905–0.968), and RF (AUC =0.920, 95% CI: 0.870–0.970). Validation of the model showed that SVM yielded the highest AUC (0.977, 95% CI: 0.952–1.000), followed by Lasso-LR (AUC =0.959, 95% CI: 0.921–0.997), XGBoost (AUC =0.958, 95% CI: 0.902–1.000), LR (AUC =0.932, 95% CI: 0.878–0.987), and RF (AUC =0.868, 95% CI: 0.779–0.958) in the testing dataset. Conclusions Our ML-based models had good discrimination in predicting patients with obstructed hydronephrosis at high risk of harboring pyonephrosis, and the use of these models may be greatly beneficial to urologists in treatment planning, patient selection, and decision-making.
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Affiliation(s)
- Hailang Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinguang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ejun Peng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ding Xia
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Canat HL, Can O, Atalay HA, Akkaş F, Ötünçtemur A. Procalcitonin as an early indicator of urosepsis following prostate biopsy. Aging Male 2020; 23:431-436. [PMID: 30290715 DOI: 10.1080/13685538.2018.1512964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To investigate the usefulness of serum procalcitonin (PCT) in the early diagnosis of urinary tract infection (UTI) and urosepsis following transrectal prostate biopsy. METHODS In this prospective observational study, 227 patients who underwent transrectal ultrasound-guided prostate biopsy were evaluated. The relationship between urosepsis and age, serum PCT, C-reactive protein, prostate-specific antigen (PSA), prostate volume, PSA density and pathologic results following biopsy was assessed. Serum PCT level was measured in all patients immediately before the biopsy and at the post-biopsy day 2. RESULTS Of the 227 patients, 11 (4.8%) developed UTI with positive urine culture without urosepsis and 5 (2.2%) developed urosepsis within 30 days after biopsy. The concentration of PCT was within the normal range before the biopsy. Procalcitonin concentration at post-biopsy day 2 was significantly higher in patients who developed urosepsis (1.91 ± 2.99 ng/ml vs. 0.05 ± 0.08 ng/ml; p = .004) compared with non-UTI patients. Only elevated PCT level at post-biopsy day 2 was a statistically significant independent predictor of post-biopsy urosepsis. The area under the ROC curve for the prediction of urosepsis was 0.976 (95%CI: 0.941-1.000) and a cut-off 0.095 ng/ml in the level of PCT at post-biopsy day 2 yielded a sensitivity of 100% and specificity of 93.8% in detecting urosepsis following biopsy. CONCLUSIONS Procalcitonin appears to be a useful early biomarker to predict the urosepsis following prostate biopsy. Patients with elevated PCT value should be closely monitored after the biopsy.
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Affiliation(s)
- Halil Lütfi Canat
- Department of Urology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Osman Can
- Department of Urology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Hasan Anıl Atalay
- Department of Urology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Fatih Akkaş
- Department of Urology, Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Alper Ötünçtemur
- Department of Urology, Okmeydanı Training and Research Hospital, Istanbul, Turkey
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Mao X, Guo H, Yao R, Bao L, Sun J, Bao Y, Guo B, Gao Y, Shi Y, Zhang H, Cui X. Crude polysaccharides from the seeds of Vaccaria segetalis prevent the urinary tract infection through the stimulation of kidney innate immunity. JOURNAL OF ETHNOPHARMACOLOGY 2020; 260:112578. [PMID: 31962152 DOI: 10.1016/j.jep.2020.112578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 11/13/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The seeds of Vaccaria segetalis (Neck.) Garcke is used for the treatment of urinary diseases in Traditional Chinese Medicine according to the Chinese Pharmacopoeia. Crude polysaccharides and the aqueous extract from the seeds of V. segetalis (SVCP) were proved to be effective on treating benign prostatic hyperplasia. AIM OF THE STUDY The aim of this study was to test the effects of SVCP on urinary tract infection (UTI) induced by uropathogenic Escherichia coli (UPEC) strain CFT073 in the rat model and to investigate the underlying mechanisms. MATERIALS AND METHODS A rat UTI model was established with the infection of UPEC strain CFT073. After oral administration of SVCP, the urinalysis and histological examination were evaluated. The levels of pro-inflammatory cytokines, procalcitonin (PCT) and polymeric Ig receptor (PIGR) were used to test the effects of SVCP on host immunity. The mRNA level of PapG in CFT073 was used to test the influence of SVCP on virulence factor. The effects of SVCP on the inhibition of bacterial adhesion were evaluated with mice UTI model. RESULTS In the rat UTI model, the levels of bacterial load, white blood cells (WBC) and red blood cells (RBC) in urine and the pathological injury in the bladder were significantly up-regulated, the expression of PIGR in kidney was down-regulated, no significant change was observed on the pro-inflammatory cytokines in urine. After oral administration of SVCP for 3 days, the levels of bacterial load, WBC and RBC in urine were significantly decreased, the pathological injury in the bladder were remarkably inhibited. The expression of IL-6, IL-8 in urine and PIGR in kidney were significantly up-regulated by SVCP (200 mg/kg). SVCP showed no effect on the concentration of PCT in serum. SVCP failed to down-regulate the mRNA level of PapG in CFT073. In the mice UTI model, pre-treatment of SVCP failed to inhibit the intracellular bacterial load in the bladder. CONCLUSIONS The therapeutic effects of SVCP on treating UTIs might result from the up-regulation of innate immunity in the kidney. SVCP can be used as an alternative therapeutic agent for UTIs.
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Affiliation(s)
- Xin Mao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Hongling Guo
- Institute of Mental Health, Peking University Sixth Hospital and National Clinical Research Center for Mental Disorders, Peking University, Beijing, 100191, China
| | - Rongmei Yao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China; College of Traditional Chinese Medicine, North China University of Sciences and Technology, Hebei, 063210, China
| | - Lei Bao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Jing Sun
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Yanyan Bao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Bo Guo
- Department of Hematology and Endocrinology, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, China
| | - Yingjie Gao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Yujing Shi
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Haijiang Zhang
- Jiangsu Key Laboratory of Regional Resource Exploitation and Medicinal Research, Huaiyin Institute of Technology, Huai'an, 223003, China; Huai'an Socal Technologies Co Ltd., Huai'an, 223003, China.
| | - Xiaolan Cui
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
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Shaikh KJ, Osio VA, Leeflang MM, Shaikh N. Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev 2020; 9:CD009185. [PMID: 32911567 PMCID: PMC8479592 DOI: 10.1002/14651858.cd009185.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In children with urinary tract infection (UTI), only those with pyelonephritis (and not cystitis) are at risk for developing long-term renal sequelae. If non-invasive biomarkers could accurately differentiate children with cystitis from children with pyelonephritis, treatment and follow-up could potentially be individualized. This is an update of a review first published in 2015. OBJECTIVES The objectives of this review were to 1) determine whether procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) can replace the acute DMSA scan in the diagnostic evaluation of children with UTI; 2) assess the influence of patient and study characteristics on the diagnostic accuracy of these tests, and 3) compare the performance of the three tests to each other. SEARCH METHODS We searched MEDLINE, EMBASE, DARE, Web of Science, and BIOSIS Previews through to 17th December 2019 for this review. The reference lists of all included articles and relevant systematic reviews were searched to identify additional studies not found through the electronic search. SELECTION CRITERIA We only considered published studies that evaluated the results of an index test (PCT, CRP, ESR) against the results of an acute-phase 99Tc-dimercaptosuccinic acid (DMSA) scan (conducted within 30 days of the UTI) in children aged 0 to 18 years with a culture-confirmed episode of UTI. The following cut-off values were used for the primary analysis: 0.5 ng/mL for procalcitonin, 20 mg/L for CRP and 30 mm/hour for ESR. DATA COLLECTION AND ANALYSIS Two authors independently applied the selection criteria to all citations and independently abstracted data. We used the bivariate model to calculate pooled random-effects pooled sensitivity and specificity values. MAIN RESULTS A total of 36 studies met our inclusion criteria. Twenty-five studies provided data for the primary analysis: 12 studies (1000 children) included data on PCT, 16 studies (1895 children) included data on CRP, and eight studies (1910 children) included data on ESR (some studies had data on more than one test). The summary sensitivity estimates (95% CI) for the PCT, CRP, ESR tests at the aforementioned cut-offs were 0.81 (0.67 to 0.90), 0.93 (0.86 to 0.96), and 0.83 (0.71 to 0.91), respectively. The summary specificity values for PCT, CRP, and ESR tests at these cut-offs were 0.76 (0.66 to 0.84), 0.37 (0.24 to 0.53), and 0.57 (0.41 to 0.72), respectively. AUTHORS' CONCLUSIONS The ESR test does not appear to be sufficiently accurate to be helpful in differentiating children with cystitis from children with pyelonephritis. A low CRP value (< 20 mg/L) appears to be somewhat useful in ruling out pyelonephritis (decreasing the probability of pyelonephritis to < 20%), but unexplained heterogeneity in the data prevents us from making recommendations at this time. The procalcitonin test seems better suited for ruling in pyelonephritis, but the limited number of studies and the marked heterogeneity between studies prevents us from reaching definitive conclusions. Thus, at present, we do not find any compelling evidence to recommend the routine use of any of these tests in clinical practice.
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Affiliation(s)
- Kai J Shaikh
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Victor A Osio
- Department of General Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Nader Shaikh
- General Academic Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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Pescatore R, Niforatos JD, Rezaie S, Swaminathan A. Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly. West J Emerg Med 2019; 20:573-577. [PMID: 31316695 PMCID: PMC6625679 DOI: 10.5811/westjem.2019.5.42096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/06/2019] [Accepted: 05/01/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction Routine interventions in the practice of medicine often lack definitive evidence or are based on evidence that is either not high quality or of only modest-to-marginal effect sizes. An abnormal urinalysis in an elderly patient presenting to the emergency department (ED) with non-specific symptoms represents one condition that requires an evidence-informed approach to diagnosis and management of either asymptomatic bacteriuria or urinary tract infection (UTI). The emergency provider often will not have access to urine cultures, and the risks associated with antibiotic use in the elderly are not without potentially significant side effects. Methods We performed a historical and clinical review of the growing body of literature suggesting measurable differences in the systemic immune response manifest among patients with asymptomatic pyuria and UTI, including increases in the pro-inflammatory cytokine interleukin-6 and the acute phase reactant procalcitonin. Results Serum procalcitonin, a peptide that undergoes proteolysis into calcitonin, has been demonstrated to quickly and reliably rise in patients with severe bacterial infections, and may serve as a potentially sensitive and specific marker for identification of bacterial illness. Conclusion In the absence of validated risk scores for diagnosing UTI in elderly patients presenting to the ED, there may be a role for the use of procalcitonin in this patient population.
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Affiliation(s)
- Richard Pescatore
- Crozer-Keystone Health System, Department of Emergency Medicine, Upland, Pennsylvania
| | - Joshua D Niforatos
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Department of Emergency Medicine Cleveland, Ohio
| | - Salim Rezaie
- Greater San Antonio Emergency Physicians, Department of Emergency Medicine, San Antonio, Texas
| | - Anand Swaminathan
- St. Joseph's Regional Medical Center, Department of Emergency Medicine, Paterson, New Jersey
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ZHAN N, ZHOU Y, MEI L, HAN Y, ZHANG H. Dual Detection of Procalcitonin and C-reactive Protein with an Up-converting Nanoparticle Based Lateral Flow Assay. ANAL SCI 2019; 35:257-263. [DOI: 10.2116/analsci.18p357] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nan ZHAN
- College of Chemistry and Molecular Engineering, Nanjing Tech University
| | - Yang ZHOU
- College of Chemistry and Molecular Engineering, Nanjing Tech University
| | - Laibao MEI
- College of Chemistry and Molecular Engineering, Nanjing Tech University
| | - Yuwang HAN
- College of Chemistry and Molecular Engineering, Nanjing Tech University
| | - Hongman ZHANG
- College of Chemistry and Molecular Engineering, Nanjing Tech University
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Levine AR, Tran M, Shepherd J, Naut E. Utility of initial procalcitonin values to predict urinary tract infection. Am J Emerg Med 2018. [PMID: 29530360 DOI: 10.1016/j.ajem.2018.03.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are one of the most common reasons women seek treatment in the emergency department (ED). The biomarker procalcitonin (PCT) has gained popularity over the last decade to improve the diagnosis of bacterial infections and reduce unnecessary exposure to antibiotics. PCT has been extensively studied in patients with pneumonia and sepsis and may have additional role in UTI. METHODS A retrospective study of patients who presented to the ED in which a urinalysis test and a PCT level was obtained within the first 24h of presentation. Signs and symptoms of UTI and urine cultures were reviewed to determine a positive diagnosis of UTI. The area under the receiver operating curve was used to calculate the test characteristics of PCT. Different breakpoints were analyzed to determine which PCT level corresponded to the highest sensitivity and specificity. RESULTS 293 patients were included in this single center, retrospective study. The AUC of PCT to predict UTI was 0.717; 95% CI: 0.643-0.791 (p<0.001). A PCT threshold of 0.25ng/ml corresponded to the best combination of sensitivity (67%) and specificity (63%), with a positive predictive value and negative predictive value of 26% and 91%, respectively. CONCLUSIONS A PCT threshold <0.25ng/ml was a strong predictor of the absence of UTI. The high negative predictive value of PCT may be useful as an adjunct to urinalysis results to rule out UTI and facilitate noninitiation or earlier discontinuation of empiric antibiotics.
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Affiliation(s)
- Alexander R Levine
- Department of Pharmacy Practice, University of Saint Joseph School of Pharmacy, United States; Department of Pharmacy, Saint Francis Hospital and Medical Center, United States.
| | - Midori Tran
- Department of Pharmacy, Kingsbrook Jewish Medical Center, United States
| | - Jonathan Shepherd
- Department of Obstetrics and Gynecology, Saint Francis Hospital and Medical Center, United States
| | - Edgar Naut
- Department of Medicine, Saint Francis Hospital and Medical Center, United States; UConn Health, United States
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Lee JH. Discrimination of culture negative pyelonephritis in children with suspected febrile urinary tract infection and negative urine culture results. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 52:598-603. [PMID: 29100793 DOI: 10.1016/j.jmii.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 08/29/2017] [Accepted: 09/04/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND We investigated whether the C-reactive protein (CRP) level, urine electrolytes, and urine sodium-potassium ratio (uNa/K) could be useful markers for discriminating children with culture negative pyelonephritis (CNP) from children with suspected febrile urinary tract infection (fUTI) and negative urine culture results. METHODS We examined 264 children experiencing their first fUTI consecutively admitted to our hospital between January 2011 and October 2014. Blood tests (CRP, white blood cell count [WBC], erythrocyte sedimentation rate [ESR], electrolytes) and urine tests (urine protein to creatinine ratio [uProt/Cr], electrolytes, uNa/K) were performed upon admission. All children with fUTI underwent 99m-dimercaptosuccinic acid (DMSA) scanning at admission. Data were compared between children with acute pyelonephritis (APN), CNP, lower UTI and controls. Using multiple logistic regression analysis (MLRA), the ability of these parameters to predict a cortical defect on DMSA scan (APN and CNP) was analyzed. RESULTS The laboratory findings of CNP children were similar with those of APN children except uProt/cr. The CRP level, WBC count, and ESR were higher in children with CNP, while uNa and uNa/K were lower than in children with lower UTI and control. By MLRA, CRP levels and uNa/K were the most relevant factors for predicting a cortical defect on DMSA scan (P = 0.002, <0.001, respectively). CONCLUSION We conclude that the combination of CRP or WBC and uNa/K are useful for discriminating children with CNP from children with suspected fUTI and negative urine culture results.
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Affiliation(s)
- Jun Ho Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
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22
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Abstract
Urinary tract infection (UTI) is the most common bacterial infection independent of age. It is also one of the most common causes of hospitalizations for infections among elderly people and the most common indication for antibiotic prescriptions in primary care. Both diagnostics and management of lower and upper urinary tract infections provide challenges in clinical practice due to their high prevalence and recurrence, and worldwide increase of antibiotic resistance. The clinical symptoms of UTI are often uncharacteristic or asymptomatic. The accurate diagnosis and early treatment are crucial due to risk of septicaemia and long-term consequences. Currently the diagnosis of urinary tract infection is based on the presence of clinical symptoms in combination with the results of nitrite strip test indicating the presence of bacteria in urine and semi-quantitative measurement of white blood cells count in urine. Although urine culture is the gold standard in UTI diagnostics it is both time-consuming and costly. Searching for novel biomarkers of UTI has attracted much attention in recent years. The article reviews several promising serum and urine biomarkers of UTI such as leukocyte esterase, C-reactive protein, procalcitonin, interleukins, elastase alpha (1)-proteinase inhibitor, lactofferin, secretory immunoglobulin A, heparin-binding protein, xanthine oxidase, myeloperoxidase, soluble triggering receptor expressed on myeloid cells-1, α-1 microglobulin (α1Mg) and tetrazolium nitroblue test (TNB).
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Lee NH, Choi HJ, Kim YH. Clinical usefulness of serum procalcitonin level in distinguishing between Kawasaki disease and other infections in febrile children. KOREAN JOURNAL OF PEDIATRICS 2017; 60:112-117. [PMID: 28461824 PMCID: PMC5410617 DOI: 10.3345/kjp.2017.60.4.112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 12/17/2022]
Abstract
Purpose The aims of this study were to compare serum procalcitonin (PCT) levels between febrile children with Kawasaki disease (KD) and those with bacterial or viral infections, and assess the clinical usefulness of PCT level in predicting KD. Methods Serum PCT levels were examined in febrile pediatric patients admitted between August 2013 and August 2014. The patients were divided into 3 groups as follows: 49 with KD, 111 with viral infections, and 24 with bacterial infections. Results The mean PCT level in the KD group was significantly lower than that in the bacterial infection group (0.82±1.73 ng/mL vs. 3.11±6.10 ng/mL, P=0.002) and insignificantly different from that in the viral infection group (0.23±0.34 ng/mL,P=0.457). The mean erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level in the KD group were significantly higher than those in the viral and bacterial infection groups (P<0.001 and P<0.001 for ESR, P<0.001 and P=0.005 for CRP, respectively). The proportion of patients in the KD group with PCT levels of >1.0 ng/mL was significantly higher in the nonresponders to the initial intravenous immunoglobulin treatment than in the responders (36% vs. 8%, P=0.01). Conclusion PCT levels may help to differentiate KD from bacterial infections. A combination of disease markers, including ESR, CRP, and PCT, may be useful for differentiating between KD and viral/bacterial infections.
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Affiliation(s)
- Na Hyun Lee
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Hee Joung Choi
- Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
| | - Yeo Hyang Kim
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
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Hildenwall H, Muro F, Jansson J, Mtove G, Reyburn H, Amos B. Point-of-care assessment of C-reactive protein and white blood cell count to identify bacterial aetiologies in malaria-negative paediatric fevers in Tanzania. Trop Med Int Health 2016; 22:286-293. [PMID: 27935664 PMCID: PMC5336187 DOI: 10.1111/tmi.12823] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective To assess the role of point‐of‐care (PoC) assessment of C‐reactive protein (CRP) and white blood cell (WBC) count to identify bacterial illness in Tanzanian children with non‐severe non‐malarial fever. Methods From the outpatient department of a district hospital in Tanzania, 428 patients between 3 months and 5 years of age who presented with fever and a negative malaria test were enrolled. All had a physical examination and bacterial cultures from blood and urine. Haemoglobin, CRP and WBC were measured by PoC devices. Results Positive blood cultures were detected in 6/428 (1.4%) children and urine cultures were positive in 24/401 (6.0%). Mean WBC was similar in children with or without bacterial illness (14.0 × 109, 95% CI 12.0–16.0 × 109 vs. 12.0 × 109, 95% CI 11.4–12.7 × 109), while mean CRP was higher in children with bacterial illness (41.0 mg/l, 95% CI 28.3–53.6 vs. 23.8 mg/l, 95% CI 17.8–27.8). In ROC analysis, the optimum cut‐off value for CRP to identify bacterial illness was 19 mg/l but with an area under the curve of only 0.62. Negative predictive values exceeded 80%, while positive predictive values were under 40%. Conclusion WBC and CRP levels had limited value in identifying children with bacterial infections. The positive predictive values for both tests were too low to be used as single tools for treatment decisions.
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Affiliation(s)
- Helena Hildenwall
- Global Health, Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Florida Muro
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jaqueline Jansson
- Global Health, Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - George Mtove
- Joint Malaria Programme, St Augustine's Hospital, Muheza, Tanzania.,National Institute for Medical Research, Amani Centre, Muheza, Tanga, Tanzania
| | - Hugh Reyburn
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ben Amos
- Joint Malaria Programme, St Augustine's Hospital, Muheza, Tanzania
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Qi X, Huang Y, Lin Z, Xu L, Yu H. Dual-Quantum-Dots-Labeled Lateral Flow Strip Rapidly Quantifies Procalcitonin and C-reactive Protein. NANOSCALE RESEARCH LETTERS 2016; 11:167. [PMID: 27013227 PMCID: PMC4807186 DOI: 10.1186/s11671-016-1383-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/20/2016] [Indexed: 05/13/2023]
Abstract
In the article, a dual-quantum-dots-labeled (dual-QDs-labeled) lateral flow strip (LFS) method was developed for the simultaneous and rapid quantitative detection of procalcitonin (PCT) and C-reactive protein (CRP) in the blood. Two QD-antibody conjugates with different fluorescence emission spectra were produced and sprayed on the LFS to capture PCT and CRP in the blood. Furthermore, a double antibody sandwich method for PCT and, meanwhile, a competitive inhibition method for CRP were employed in the LFS. For PCT and CRP in serum assayed by the dual-QDs-labeled LFS, their detection sensitivities reached 0.1 and 1 ng/mL, respectively, and their linear quantitative detection ranges were from 0.3 to 200 ng/mL and from 50 to 250 μg/mL, respectively. There was little evidence that the PCT and CRP assays would be interfered with each other. The correlations for testing CRP and PCT in clinical samples were 99.75 and 97.02 %, respectively, between the dual-QDs-labeled LFS we developed and commercial methods. The rapid quantification of PCT and CRP on dual-QDs-labeled LFS is of great clinical value to distinguish inflammation, bacterial infection, or viral infection and to provide guidance for the use of antibiotics or other medicines.
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Affiliation(s)
- XiaoPing Qi
- Shenzhen Sixth People's Hospital, Shenzhen, 518052, People's Republic of China
| | - YunYe Huang
- Biomedical Engineering, Shenzhen Polytechnic, Shenzhen, 518055, People's Republic of China
| | - ZhongShi Lin
- Shenzhen Institute for Drug Control, Shenzhen, 518057, People's Republic of China
| | - Liang Xu
- Shenzhen Institute for Drug Control, Shenzhen, 518057, People's Republic of China
| | - Hao Yu
- Biomedical Engineering, Shenzhen Polytechnic, Shenzhen, 518055, People's Republic of China.
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Fang J, Luan J, Zhu G, Qi C, Wang D. Detection of PCT and urinary β 2 -MG enhances the accuracy for localization diagnosing pediatric urinary tract infection. J Clin Lab Anal 2016; 31. [PMID: 27801524 PMCID: PMC6816850 DOI: 10.1002/jcla.22088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/06/2016] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The purpose of this article was to investigate whether the combination of urinary beta 2 microglobulin (urinary β2 -MG) and procalcitonin (PCT) diagnosis could enhance the localization diagnostic precision of pediatric urinary tract infection comparing with single diagnosis. METHODS A study was conducted in the Nephrology Department of Wuhan women and children's health care centre. This study incorporated 85 participants, including 35 children who were diagnosed as upper urinary tract infection (UUTI) with the symptom of fever and 50 children who conducted lower urinary tract infection (LUTI). Levels of PCT and urinary β2 -MG in both UUTI and LUTI patients were measured and compared. RESULTS The level of PCT and β2 -MG were both significantly higher in UUTI group compared with in LUTI group. AUC of urinary β2 -MG ROC (sensitivity of 71.4%, specificity of 90.0%) was significantly smaller than that of PCT ROC (sensitivity of 77.1%, specificity of 96.0%) in the single diagnosis. Although in the combined diagnosis, the sensitivity and specificity increased to 88.6% and 98%, respectively. CONCLUSIONS Both PCT and β2 -MG could be used to localize the UTI. Introducing urinary β2 -MG into PCT diagnosis could increase the sensitivity and specificity of UTI lesion diagnosis in clinical practice.
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Affiliation(s)
- Jian Fang
- Department of NephrologyWuhan Women and Children's Health Care CenterWuhanHubeiChina
| | - Jiangwei Luan
- Department of NephrologyWuhan Women and Children's Health Care CenterWuhanHubeiChina
| | - Gaohong Zhu
- Department of NephrologyWuhan Women and Children's Health Care CenterWuhanHubeiChina
| | - Chang Qi
- Department of NephrologyWuhan Women and Children's Health Care CenterWuhanHubeiChina
| | - Dandan Wang
- Department of Cardiovascular MedicineWuhan Women and Children's Health Care CenterWuhanHubeiChina
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Fritzenwanker M, Imirzalioglu C, Chakraborty T, Wagenlehner FM. Modern diagnostic methods for urinary tract infections. Expert Rev Anti Infect Ther 2016; 14:1047-1063. [DOI: 10.1080/14787210.2016.1236685] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Al-Hakeim HK, Al-Ankoshy AM, Alsharifi MR. Efficiency of Fetuin-A and Procalcitonin in the Diagnosis of Infection in Patients with Febrile Seizure. ACTA FACULTATIS MEDICAE NAISSENSIS 2016. [DOI: 10.1515/afmnai-2016-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
Fetuin-A is a negative acute phase reactant, while procalcitonin is an indicator of severe bacterial infection. Diagnosis of bacterial infection in febrile seizure (FS) is important for choosing the most suitable treatment. In this study, serum fetuin-A was estimated, for the first time, in the inpatients with FS and compared with procalcitonin and blood culture tests.
A total of 60 children (28 male and 32 female) with FS in addition to 30 sex- and age-matched children participated in the study. Patients were classified according to sex, age, PCT level (high PCT>0.5ng/mL), C-reactive protein (CRP, positive >6mg/L), and according to the results of the blood culture.
Fetuin-A level decreased and PCT level increased in FS patients in comparison to those in the control group. These changes are significantly increased (p<0.05) in the positive CRP group compared with that of the negative CRP group. Kernel density estimation showed that procalcitonin is a better indicator of the infection in FS children than fetuin-A . Procalcitonin is more sensitive and specific than fetuin-A and when used together they produce 100% sensitivity and specificity for the diagnosis of bacterial infection in FS patients.
Fetuin-A is low in FS patients and can be used with procalcitonin in the diagnosis of bacterial infection in FS.
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Diagnostic value of serum procalcitonin for acute pyelonephritis in infants and children with urinary tract infections: an updated meta-analysis. World J Urol 2015; 34:431-41. [DOI: 10.1007/s00345-015-1630-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 06/05/2015] [Indexed: 10/23/2022] Open
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30
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Yang WE, Woods CW, Tsalik EL. Host-Based Diagnostics for Detection and Prognosis of Infectious Diseases. J Microbiol Methods 2015. [DOI: 10.1016/bs.mim.2015.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kanai H, Sato H, Takei Y. Community-acquired methicillin-resistant Staphylococcus epidermidis pyelonephritis in a child: a case report. J Med Case Rep 2014; 8:415. [PMID: 25488491 PMCID: PMC4308012 DOI: 10.1186/1752-1947-8-415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 10/30/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction Staphylococcus epidermidis is currently the most frequent pathogen of opportunistic and nosocomial infections worldwide. Most cases of Staphylococcus epidermidis infections are associated with indwelling medical devices and/or immunocompromised conditions. Community-acquired urinary tract infections are rare, particularly among pediatric populations, and clinicians often do not consider Staphylococcus epidermidis as a uropathogen. Case presentation A previously healthy Japanese boy developed pyelonephritis caused by Enterococcus faecalis at 10 months of age. Subsequently, he was diagnosed with severe bilateral vesicoureteral reflux (right side grade V, left side grade III), and was administered trimethoprim/sulfamethoxazole as the prophylaxis. At 18 months of age, he presented with fever. Gram staining of urine obtained through catheterization revealed gram-positive cocci. We suspected pyelonephritis caused by enterococci, and administered oral fluoroquinolone empirically. The fever promptly resolved, and eventually, methicillin-resistant Staphylococcus epidermidis was detected at significant levels in the urine. Thus, our final diagnosis was pyelonephritis caused by community-acquired methicillin-resistant Staphylococcus epidermidis. Conclusions Our case indicated that even immunocompetent children without a urinary catheter can develop Staphylococcus epidermidis pyelonephritis. Staphylococcus epidermidis can be underdiagnosed or misdiagnosed as sample contamination in community-acquired urinary tract infections. Therefore, when Gram staining of appropriately obtained urine samples reveals gram-positive cocci, clinicians should take into consideration not only the possibility of enterococci but also staphylococci, including Staphylococcus epidermidis, particularly in children with urinary abnormalities and/or those receiving continuous antibiotic prophylaxis.
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Affiliation(s)
- Hiroaki Kanai
- Department of Pediatrics, Suwa Central Hospital, Tamagawa 4300, Chino-city, Nagano 391-8503, Japan.
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