Procalcitonina y proteína C reactiva versus hemocultivos en el diagnóstico de sepsis
DOI:
https://doi.org/10.33936/qkrcs.v7i3.6386Palavras-chave:
sepsis, cultivo de sangre, polipéptido alfa relacionado con calcitonina, proteína C-reactiva, Unidad de Cuidados Intensivos.Resumo
La sepsis es una condición prevenible altamente mortal que genera
disfunción orgánica. Los hemocultivos son una herramienta esencial ante su sospecha, sin embargo, sus limitaciones impulsan el uso de otros
marcadores para identificar pacientes infectados y determinar gravedad. Este
trabajo analizó la procalcitonina y proteína C reactiva versus emocultivos
en el diagnóstico de sepsis en la Unidad de Cuidados Intensivos del
Hospital General Portoviejo durante el período noviembre 2022-mayo
2023. La investigación fue observacional, descriptiva, retrospectiva y transversal. Se analizó una base de datos anonimizada que constaba de variables demográficas y analíticas. En la muestra (n = 108) predominó el género femenino, la edad promedio fue 65 ± 18 años y prevalecieron los hemocultivos negativos. Los pacientes con hemocultivos positivos (n = 25)
tuvieron con mayor frecuencia aislamientos de Escherichia coli asociados a foco urinario y Staphylococcus aureus de origen no especificado. En sepsis de origen indeterminado y urinario los valores promedio de procalcitonina y proteína C reactiva fueron superiores en el grupo de hemocultivos positivos,
a diferencia del conteo total de leucocitos que fue superior en el grupo de hemocultivos negativos. En la comparación de las concentraciones de estos
tres marcadores entre grupos, se observaron diferencias estadísticamente
significativas para procalcitonina y proteína C reactiva.
Downloads
Referências
Neira E, Málaga G. Sepsis-3 y las nuevas definiciones, ¿es tiempo de abandonar SIRS? Acta méd Perú [Internet]. 2016;33(3):217–22. Disponible en: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1728-59172016000300008&lng=es.
World Health Organization. Global report on the epidemiology and burden of sepsis: current evidence, identifying gaps and future directions. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO. Disponible en: https://www.who.int/publications/i/item/9789240010789
Gregoriano C, Heilmann E, Molitor A, Schuetz P. Role of procalcitonin use in the management of sepsis. J Thorac Dis [Internet]. 2020;12(S1): S5–S15. Disponible en: https://doi.org/10.21037/jtd.2019.11.63
Jiménez S, Palacios Z, Rosso C, Girón J, Rodriguez J, Retamar P. Opportunities for antibiotic optimisation and outcome improvement in patients with negative blood cultures: study protocol for a cluster-randomised crossover trial, the NO-BACT study. BMJ Open [Internet]. 2019;9(12):e030062. Disponible en: https://doi.org/10.1136/
bmjopen-2019-030062
Ombelet S, Barbé B, Affolabi D, Ronat JB, Lompo P, Lunguya O, et al. Best Practices of Blood Cultures in Lowand Middle-Income Countries. Front Med (Lausanne) [Internet]. 2019;6:131; 1-27. Disponible en: https://doi.
org/10.3389/fmed.2019.00131
Yang L, Lin Y, Wang J, Song J, Wei B, Zhang X, et al. Comparison of Clinical Characteristics and Outcomes Between Positive and Negative Blood Culture Septic Patients: A Retrospective Cohort Study. Infect Drug Resist [Internet]. 2021;14:4191–4205. Disponible en: https://doi.org/10.2147/IDR.S334161
Rodríguez Y, Rodríguez M, Lemes Y, Quesada Y. Caracterización clínica, epidemiológica y microbiológica de pacientes con sepsis en una Unidad de Cuidados Intensivos. MEDISAN [Internet]. 2020;24(2). Disponible en:
https://medisan.sld.cu/index.php/san/article/view/2853
Ibáñez E, Fretes A, Duarte L, Giménez F, Olmedo E, Figueredo H, et al. Caracterización de la sepsis en pacientes adultos del Hospital Nacional. Rev virtual Soc Parag Med Int [Internet]. 2022;9(1): 62-70. Disponible en: https://doi.org/10.18004/rvspmi/2312-3893/2022.09.01.62
Escobar J, Ortíz S, Villalba R. Factores asociados a la mortalidad en pacientes con sepsis y choque séptico de la unidad de cuidados intensivos de adultos de un hospital de Paraguay. Rev. virtual Soc. Parag. Med. Int. [Internet].
;8(2):44–56. Disponible en: https://doi.org/10.18004/rvspmi/2312-3893/2021.08.02.44
Longhi G, Grunewald G, Vignardi D, Oenning da Gama F, Silva F. Desfecho clínico e fatores associados ao óbito
em pacientes com sepse internados em Unidade de Terapia Intensiva. Arq Catarin Med [Internet]. 2020;49(1):2–9.
Disponible en: https://revista.acm.org.br/index.php/arquivos/article/view/528
Arshid W, Mehta N, Mahajan B, Slathia P, Misger M, Kaila D, et al. Antibiotic Sensitivity and Resistance Pattern
of Bacterial Isolates from Blood Culture in Intensive Care Unit Patients of TertiaryCare Hospital In North India.
Int J Life Sci Biotechnol Pharma Res [Internet]. 2023;12(1):157–163. Disponible en: http://www.ijlbpr.com/
uploadfiles/34vol12issue1pp157-163.20230322050438.pdf
Beenakker K, Westendorp R, De Craen A, Chen S, Raz Y, Ballieux B, et al. Men Have a Stronger MonocyteDerived Cytokine Production Response upon Stimulation with the Gram-Negative Stimulus Lipopolysaccharide
than Women: A Pooled Analysis Including 15 Study Populations. J Innate Immun [Internet]. 2020;12(2):142–153. Disponible en: https://doi.org/10.1159/000499840
Hazwani T, Kazzaz Y, Alsugheir S, Aldelaijan S, Alsugheir F, Alali H, et al. Association Between Culture-Negative Versus Culture-Positive Sepsis and Outcomes of Patients Admitted to the Pediatric Intensive Care Unit. Cureus [Internet]. 2020;12(8):e9981. Disponible en: https://doi.org/10.7759/cureus.9981
Thorndike J, Kollef M. Culture-negative sepsis. Curr Opin Crit Care [Internet]. 2020;26(5):473–477. Disponible en: https://doi.org/10.1097/MCC.0000000000000751
Escobar J, Gómez M, Ramírez T, Romero J. Características clínicas y epidemiológicas de los pacientes con sepsis
de la unidad de terapia intensiva adultos del Hospital Regional de Coronel Oviedo, Paraguay. Rev virtual Soc Parag
Med Int [Internet]. 2021;8(1):52–60. Disponible en: https://doi.org/10.18004/rvspmi/2312-3893/2021.08.01.52Opportunities for antibiotic optimisation and outcome improvement in patients with negative blood cultures: study protocol for a cluster-randomised crossover trial, the NO-BACT study. BMJ Open [Internet]. 2019;9(12):e030062. Available from: https://doi.org/10.1136/bmjopen-2019-030062
Ombelet S, Barbé B, Affolabi D, Ronat JB, Lompo P, Lunguya O, et al. Best Practices of Blood Cultures in Low- and Middle-Income Countries. Front Med (Lausanne) [Internet]. 2019;6:131; 1-27. Available from: https://doi.org/10.3389/fmed.2019.00131
Yang L, Lin Y, Wang J, Song J, Wei B, Zhang X, et al. Comparison of Clinical Characteristics and Outcomes Between Positive and Negative Blood Culture Septic Patients: A Retrospective Cohort Study. Infect Drug Resist [Internet]. 2021;14:4191–4205. Available from: https://doi.org/10.2147/IDR.S334161
Rodríguez Y, Rodríguez M, Lemes Y, Quesada Y. Caracterización clínica, epidemiológica y microbiológica de pacientes con sepsis en una Unidad de Cuidados Intensivos. MEDISAN [Internet]. 2020;24(2). Disponible en: https://medisan.sld.cu/index.php/san/article/view/2853
Ibáñez E, Fretes A, Duarte L, Giménez F, Olmedo E, Figueredo H, et al. Caracterización de la sepsis en pacientes adultos del Hospital Nacional. Rev virtual Soc Parag Med Int [Internet]. 2022;9(1): 62-70. Disponible en: https://doi.org/10.18004/rvspmi/2312-3893/2022.09.01.62
Escobar J, Ortíz S, Villalba R. Factores asociados a la mortalidad en pacientes con sepsis y choque séptico de la unidad de cuidados intensivos de adultos de un hospital de Paraguay. Rev. virtual Soc. Parag. Med. Int. [Internet]. 2021;8(2):44–56. Disponible en: https://doi.org/10.18004/rvspmi/2312-3893/2021.08.02.44
Longhi G, Grunewald G, Vignardi D, Oenning da Gama F, Silva F. Desfecho clínico e fatores associados ao óbito em pacientes com sepse internados em Unidade de Terapia Intensiva. Arq Catarin Med [Internet]. 2020;49(1):2–9. Disponível em: https://revista.acm.org.br/index.php/arquivos/article/view/528
Arshid W, Mehta N, Mahajan B, Slathia P, Misger M, Kaila D, et al. Antibiotic Sensitivity and Resistance Pattern of Bacterial Isolates from Blood Culture in Intensive Care Unit Patients of TertiaryCare Hospital In North India. Int J Life Sci Biotechnol Pharma Res [Internet]. 2023;12(1):157–163. Available from: http://www.ijlbpr.com/uploadfiles/34vol12issue1pp157-163.20230322050438.pdf
Beenakker K, Westendorp R, De Craen A, Chen S, Raz Y, Ballieux B, et al. Men Have a Stronger Monocyte-Derived Cytokine Production Response upon Stimulation with the Gram-Negative Stimulus Lipopolysaccharide than Women: A Pooled Analysis Including 15 Study Populations. J Innate Immun [Internet]. 2020;12(2):142–153. Available from: https://doi.org/10.1159/000499840
Hazwani T, Kazzaz Y, Alsugheir S, Aldelaijan S, Alsugheir F, Alali H, et al. Association Between Culture-Negative Versus Culture-Positive Sepsis and Outcomes of Patients Admitted to the Pediatric Intensive Care Unit. Cureus [Internet]. 2020;12(8):e9981. Available from: https://doi.org/10.7759/cureus.9981
Thorndike J, Kollef M. Culture-negative sepsis. Curr Opin Crit Care [Internet]. 2020;26(5):473–477. Available from: https://doi.org/10.1097/MCC.0000000000000751
Escobar J, Gómez M, Ramírez T, Romero J. Características clínicas y epidemiológicas de los pacientes con sepsis de la unidad de terapia intensiva adultos del Hospital Regional de Coronel Oviedo, Paraguay. Rev virtual Soc Parag Med Int [Internet]. 2021;8(1):52–60. Disponible en: https://doi.org/10.18004/rvspmi/2312-3893/2021.08.01.52
Prescott H. The Epidemiology of Sepsis. In: Wiersinga, W., Seymour, C. (eds). Handbook of Sepsis. Springer, Cham; 2018:15–28. Available from: https://doi.org/10.1007/978-3-319-73506-1_2
Yoshikawa T, Reyes B, Ouslander J. Sepsis in Older Adults in Long‐Term Care Facilities: Challenges in Diagnosis and Management. J Am Geriatr Soc [Internet]. 2019;67(11):2234–2239. Available from: https://doi.org/10.1111/jgs.16194
Thaden J, Cantrell S, Dagher M, Tao Y, Ruffin F, Maskarinec S, et al. Association of Follow-up Blood Cultures With Mortality in Patients With Gram-Negative Bloodstream Infections. JAMA Netw Open [Internet]. 2022;5(9):e2232576. Available from: https://doi.org/10.1001/jamanetworkopen.2022.32576
Li Y, Guo J, Yang H, Li H, Shen Y, Zhang D. Comparison of culture-negative and culture-positive sepsis or septic shock: a systematic review and meta-analysis. Crit Care [Internet]. 2021;25(167):1-9. Available from: https://doi.org/10.1186/s13054-021-03592-8
Rodriguez L. Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs Context [Internet]. 2020;9 9:1–8. Available from: https://doi.org/10.7573/dic.2020-4-13
Anton V, Planche T. Gram-negative blood stream infections: prospects and challenges of rapid antimicrobial susceptibility testing. Expert Rev Anti Infect Ther [Internet]. 2022;20(4):483–485. Available from: https://doi.org/10.1080/14787210.2022.1999805
Leibovici Y, Tau N, Yahav D. Bloodstream infections in the elderly: what is the real goal? Aging Clin Exp Res [Internet]. 2021;33(4):1101–1112. Available from: https://doi.org/10.1007/s40520-019-01337-w
Fabre V, Sharara S, Salinas A, Carroll K, Desai S, Cosgrove S. Does This Patient Need Blood Cultures? A Scoping Review of Indications for Blood Cultures in Adult Nonneutropenic Inpatients. Clinical Infectious Diseases [Internet]. 2020;71(5):1339–1347. Available from: https://doi.org/10.1093/cid/ciaa039
Kimmig A, Hagel S, Weis S, Bahrs C, Löffler B, Pletz M. Management of Staphylococcus aureus Bloodstream Infections. Front Med (Lausanne) [Internet]. 2021;7. Available from: https://doi.org/10.3389/fmed.2020.616524
Bonten M, Johnson J, Van den Biggelaar A, Georgalis L, Geurtsen J, De Palacios P, et al. Epidemiology of Escherichia coli Bacteremia: A Systematic Literature Review. Clinical Infectious Diseases [Internet]. 2021;72(7):1211–1219. Available from: https://doi.org/10.1093/cid/ciaa210
Assoni L, Girardello R, Converso T, Darrieux M. Current Stage in the Development of Klebsiella pneumoniae Vaccines. Infect Dis Ther [Internet]. 2021;10(4):2157–2175. Available from: https://doi.org/10.1007/s40121-021-00533-4
Napolitano L. Intra-abdominal Infections. Semin Respir Crit Care Med [Internet]. 2022;43(01):010–27. Available from: https://doi.org/10.1055/s-0041-1741053
Webb A, Kramer N, Stead T, Mangal R, Lebowitz D, Dub L, et al. Serum Procalcitonin Level Is Associated with Positive Blood Cultures, In-hospital Mortality, and Septic Shock in Emergency Department Sepsis Patients. Cureus [Internet]. 2020; 12(4):e7812. Available from: https://doi.org/10.7759/cureus.7812
Farkas J. The complete blood count to diagnose septic shock. J Thorac Dis [Internet]. 2020;12(S1):S16–21. Available from: https://doi.org/10.21037/jtd.2019.12.63
Bassetti M, Russo A, Righi E, Dolso E, Merelli M, Cannarsa N, et al. Comparison between procalcitonin and C-reactive protein to predict blood culture results in ICU patients. Crit Care [Internet]. 2018 ;22 (252): 1-2. Available from: https://doi.org/10.1186/s13054-018-2183-x
Anugu N, Khan S. Comparing the Diagnostic Accuracy of Procalcitonin and C-Reactive Protein in Neonatal Sepsis: A Systematic Review. Cureus [Internet]. 2021;13(1):e19485. Available from: https://doi.org/10.7759/cureus.19485
Hassan J, Khan S, Zahra R, Razaq A, Zain A, Razaq L, et al. Role of Procalcitonin and C-reactive Protein as Predictors of Sepsis and in Managing Sepsis in Postoperative Patients: A Systematic Review. Cureus [Internet]. 2022; 14(11): e31067. Available from: https://doi.org/10.7759/cureus.31067
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2024 Maureen Nathali Cedeño Zambrano, Jorge Washington Pachay Solórzano
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
