271
￭ Sat-431 ￭
Delta neutrophil index:a early diagnostic and prognostic marker for candidemia in adult patients
1한림대학교 강동성심병원 내과, 2한림대학교 강동성심병원 진단검사 의학과
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김경호
1, 박소연
1, 시혜진
1, 이진서
1, 박지영
2Background/Aims: Candidemia is associated with high mortality. Although prompt initiation of antifungal therapy is essential an improvement of prog- nosis, early diagnosis of candidemia remains a challenge. Recent models of automatic cell analyzers provide the delta neutrophil index (DNI), which corre- sponds to the fraction of immature granulocytes in circulating blood. This study evaluated the diagnostic accuracy of DNI as a predictive and prognostic factor in patients with candidemia. Methods: We retrospectively collected data on adult patients with candidemia admitted to Kangdong Sacred Heart Hospital between July 2016 and June 2018. Control patients were chosen by matching the date the blood culture was conducted (± 5 days) and the blood culture result was negative. DNI data on the day of the first blood culture were compared among the groups, and 14-day mortality associated with candide- mia was assessed. Results: A total of 65 patients with candidemia were identified and matched to 65 control patients (table 1). Candidemia group had sig- nificantly higher DNI values than control group (3.40% vs 1.25%, P <0.001)(Table 2. In multivariate analysis, DNI was a significant independent factor for predicting candidemia (odd ratio 1.295; 95% con-
fidence interval 〔CI〕 1.058-1.584, P=0.012). The area under the receiver operating curve for DNI value to predict candidemia was 0.775 (95% CI;
0.691-0.860, P <0.001). The best cutoff value for DNI for predicting candidemia was 2.75%.DNI was sig- nificantly higher in those who died than in the survi- vors in candidemia group (14.7% vs 3.30%, P
<0.001) and was identified to be an independent pre- dictor for 14-day mortality in patients with candide- mia Conclusions: DNI is a potentially useful diag- nostic and predict mortality among patients with candidemia. Thus, these finding suggest that DNI may be a useful marker in the management of pa- tients with candidemia.
￭ Sat-432 ￭
Diagnostic usefulness of molecular detection of C. burnetii in patients with suspected acute Q fever
1울산대학교 의과대학 서울아산병원 감염내과, 2울산대학교 융합의학과
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배문숙
1, 진충은
2, 박정하
1, 김민재
1, 최상호
1, 김양수
1, 우준희
1, 신용
2, 김성한
1Background/Aims: Diagnosis of Q fever is difficult because there is a lack of distinct clinical features distinguishing it from other febrile diseases. The serologic test is the gold standard diagnostic method but requires serum from the acute and convalescent stages of infection, which limits early diagnosis. We thus evaluated the diagnostic utility of Q fever PCR from the blood in patients with suspected acute Q fever patients.
Methods: All adult patients with suspected acute Q fever prospectively were enroll at a tertiary hospital, Seoul, South Korea, from Feb 2016 through June 2018. Acute Q fe- ver was diagnosed on the basis of association of clinical evidence and laboratory cri- teria: (1) fever with at least one other symptoms (rigors, headache, and pneumonia or elevated liver enzymes) and (2) single phase II immunoglobulin G (IgG) antibodies titer
≥1:200, IgM antibodies titer ≥1:50 by IFA (probable cases), or four-fold or sero- conversion in phase II IgG antibody titer by IFA between two separate samples obtained two or more weeks apart (confirmed cases). We performed PCR testing from blood to target the transposase genes insertion element IS1111a of Coxiella burnetii. Results: Of the 34 patients suspected of having acute Q fever, 6 were diagnosed as confirmed Q fe- ver and 10 as probable Q fever. The remaining 18 patients were diagnosed as other fe- brile diseases; hematologic malignancy (n=5, 28%), rheumatologic disease (n=4, 22%), drug hypersensitivity (n=3, 17%), and other infectious disease (n=6, 33%). The clinical characteristics between 16 patients with Q fever and 18 patients with other febrile dis- eases are shown in Table 1. Patients with Q fever had the higher proportion of males than patients with other febrile disease (88% vs. 44%, p=0.01), but there were no sig- nificant differences between two groups in other clinical features. The Q fever PCR test- ing was positive in 88% ([14/16], 95% CI 62-98) of patients with confirmed and prob- able acute Q fever and was positive in 11% ([2/18], 95% CI 2-36) of patients with other febrile diseases. Conclusions: Q fever PCR testing from the blood in patients with sus- pected acute Q fever appears to be a rapid and useful tool for early diagnosis of Q fever.
