אבחון זיהום בקטריאלי בשפעת

Procalcitonin and C-Reactive Protein Levels Might Help Detect Bacterial Infection in Patients with H1N1 Influenza --------------------------------------------------------- A combination of procalcitonin level >0.8 ng/mL and CRP level >200 mg/L had a 90% positive predictive value for distinguishing bacterial or mixed bacterial/H1N1 infection from H1N1 infection. The biomarker procalcitonin shows promise for distinguishing between viral and bacterial infections. To determine the predictive value of procalcitonin and C-reactive protein (CRP) levels for distinguishing between 2009 H1N1 influenza infection and bacterial or mixed H1N1/bacterial infection, researchers performed a retrospective observational study of 16 patients with H1N1 infection and 9 patients with bacterial or mixed infection who were admitted to an Australian intensive care unit (ICU). Patients with H1N1 infection alone had significantly more bilateral infiltrates, lower APACHE scores, lower median white blood cell counts, and longer ICU stays than those with bacterial or mixed infection, but none of these findings were useful discriminators. At a cutoff value of >0.8 ng/mL, procalcitonin level on admission was 100% sensitive and 62% specific for identifying patients with bacterial or mixed infection. A CRP value of >200 mg/L on admission was also 100% sensitive and even more specific (87%). Combining procalcitonin and CRP at those same cutoff levels increased specificity to 94% while maintaining sensitivity at 100% and yielded a positive predictive value of 90%. Comment: This very small study adds to others that suggest that procalcitonin or other biomarker levels might someday help determine which patients need antibiotics (JW Emerg Med Feb 5 2010). These tests are not sufficiently validated, so don't order that procalcitonin or CRP level just yet! — Kristi L. Koenig, MD, FACEP Published in Journal Watch Emergency Medicine February 19, 2010

אלה שהיה להם במחקר מעל 200 CRP היו אלה עם ש. החזירים או עם זיהום חיידקי?