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Background: Sepsis is defined as life-threatening organ dysfunction caused by an abnormal host response to infection. The study aimed to evaluate the utility of presepsin (P-SEP) in predicting the risk of death in patients with sepsis at the time of intensive care unit (ICU) admission. Methods: Adult patients were included in the study if they met SEPSIS-3 criteria at ICU admission. Demographic and clinical data were collected. The following inflammatory parameters were determined: C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and presepsin (P-SEP). Material was collected for microbiological testing depending on the suspected source of infection. The primary endpoint was patient death before ICU discharge. The secondary endpoint was a positive microbiological test result. Results: Eighty-six patients were included in the study. Thirty patients (35%) died before discharge from the ICU. There was no difference in P-SEP, CRP, PCT, and IL-6 values between patients who survived and those who died (p > 0.05 for all). P-SEP, CRP, PCT, and IL-6 were determined at ICU admission and did not accurately predict the risk of death in ROC curve analysis (p > 0.05 for all). Confirmation of the location of the focus of bacterial infection by microbiological testing was obtained in 43 (49%) patients. P-SEP, PCT, CRP, and IL-6 were significantly higher in patients with positive microbiological findings. Conclusions: In patients with suspected sepsis admitted to the Intensive Care Unit, presepsin does not accurately predict the risk of in-hospital death, but it can predict a positive microbiological culture. [ABSTRACT FROM AUTHOR]

Introduction. Sepsis-associated brain dysfunction is a common organ dysfunction in sepsis. The main goal of this study was to verify whether the combined assessment of central nervous system injury markers (i.e. S100B, NSE, GFAP) and disease severity as per the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and Sequential Organ Failure Assessment (SOFA) classification systems, would increase the accuracy of death prediction in septic shock. Material and methods. Markers of neuronal damage were determined in 55 patients diagnosed with septic shock with no previous neurological disease. Clinical data was collected and the scores on the APACHE II, SAPS II and SOFA prognostic scales were calculated. Death before discharge from the Intensive Care Unit (ICU) was established as the endpoint. Results. Nineteen patients (35%) died before ICU discharge. Patients who died had significantly higher S100B and NSE values, and APACHE II, SAPS II and SOFA scores (p < 0.05 for all). At the time of septic shock diagnosis, NSE levels more accurately predicted the risk of death before ICU discharge than S100B. However, NSE had no better predictive value for short-term mortality than APACHE II, SAPS II and SOFA. Adding C-reactive protein (CRP) and S100B concentrations to the APACHE II score created a predictive model with 95% mortality accuracy (AUC = 0.95; 95% CI 0.85-0.99; p = 0.03). Conclusions. The assessment of acute neuronal injury plays an important role in prognostication in patients with septic shock. The concentration of S100B protein in combination with APACHE II score and concentration of CRP more accurately predicts mortality than the APACHE II alone. [ABSTRACT FROM AUTHOR]

Introduction. Inappropriate antibiotic therapy is responsible for the selection of multi-drug resistant strains and may pose a significant public health problem. During the COVID-19 pandemic, due to lack of evidence-based knowledge, the approach to antibiotic therapy varied between hospitals and predominantly depended on local protocols and individual physicians' decisions. The aim of this study was to assess antibiotic consumption during the COVID-19 pandemic compared to the pre-pandemic period in critically ill subjects in a tertiary intensive care unit (ICU). Methods. The annual changes in antibiotic consumption from 2018 until 2022 in a multidisciplinary ICU was analyzed retrospectively. Data on antibiotic consumption were obtained from the hospital pharmacy and calculated as daily defined dose (DDD) for individual groups of drugs. Results. During the pandemic period, fewer hospitalizations were observed, but they were longer. The overall antibiotic consumption in critically ill patients decreased compared to the pre-pandemic period. Among particular group of drugs, only aminoglycosides and clindamycin were prescribed more frequently. Conclusions. During COVID-19, the overall antibiotic consumption decreased, requiring further research to determine the reasons for this favorable trend. [ABSTRACT FROM AUTHOR]

Introduction: The need for prolonged mechanical ventilation (MV) in patients with subarachnoid haemorrhage (SAH) increases the risk of developing ventilation-associated pneumonia (VAP). Aim of the research: To assess the prevalence of VAP and to determine its aetiological factors. Material and methods: The study group consisted of 58 critically ill patients treated between 01.2019 and 10.2021. Demographic and clinical data were collected, including the method of collecting material from the respiratory tract, and results of laboratory and microbiological tests. Results: More than 97% of patients were intubated on the day of admission to the ICU. The median duration of MV was 8 days (IQR: 3-19). On admission, 47 microbiological samples from the respiratory tract (39 endotracheal aspirates, 8 bronchopulmonary lavage) were collected, 26 of which (55%) were physiological flora. In the following days, VAP was diagnosed in 9/47 patients (19%). The median time from admission to diagnosis was 3.5 days (IQR: 3-4.5). Multi-drug-resistant species were found in 3 patients (K. pneumoniae ESBL+). In-hospital mortality among patients with VAP was 62%. None of the patients with SAH and VAP was liberated from ventilator. Conclusions: In patients with SAH, early-onset VAP is frequent, and its aetiology is unrelated with bacterial colonization found on ICU admission. Even in EO-VAP, multidrug-resistant (MDR) bacteria must be suspected, mostly causing hospitalacquired pneumonia. Prognosis of patients with SAH who develop VAP is poor. [ABSTRACT FROM AUTHOR]

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Although intradermal testing (IDT) is commonly used in the etiological diagnosis of allergies, in vitro testing for specific IgE (sIgE) is an attractive alternative. Currently, new laboratory techniques in veterinary allergological practice, including multiple allergen simultaneous tests (MASTs), gradually supersede in vivo tests. Both, serological (sIgE) and IDTs in fourteen atopic Malopolski horses were performed. Correlation and agreement between test results were evaluated. Receiver operating characteristic analysis showed that sIgE to Acarus siro had the best diagnostic performance (Area under the ROC curve [AUC] = 0.969), followed by Dermatophagoides pteronyssinus (AUC = 0.844), Dermatophagoides farinae (AUC = 0.813) and Tyrophagus putrescentiae (AUC = 0.803). A significant positive correlation between IDT and MAST was found for A. siro (rS = 0.870; p= 0.00005), and D. farinae (rS = 0.657; p = 0.011). There was significant moderate agreement for 2 of 5 allergens, A. siro (κ = 0.569) and D. farinae (κ = 0.485) in semiquantitative assessment and significant fair to substantial agreement for 3 of 5 allergens, D.pteronyssinus(κ = 0.689), A. siro (κ = 0.569), D. farinae (κ = 0.432) in dichotomic assessment. Sensitivity ranged from 44% to 89%, depending on the allergen, while specificity was significantly higher for all allergens in MAST (60%-100%); the mean accuracy was 73% (manufacturer cut-off) and 77.4% (optimal cut-off) based on the Youden index. Compared with IDT, serological MAST showed good detection performance for 60% allergen sIgE in dichotomic assessment with substantial diagnostic capability, but careful clinical interpretation is needed for some allergens. [ABSTRACT FROM AUTHOR]

Abstract New techniques in equine veterinary allergy testing include multiple allergen simultaneous tests (MASTs) that cover insect bite hypersensitivity (IBH), respiratory and atopic allergic diseases. The in vivo intradermal test (IDT) method is one of the most widely used techniques in veterinary practice, but recently, in vitro methods have been introduced as possible alternatives. This study was designed to assess the correlation between IDTs and MASTs based on IgE determination in serum. The study was performed on Malopolski breed horses with IBH (n = 26). IDTs were performed, and allergen-specific IgE serum concentrations were measured using a monoclonal anti-IgE antibody during the years 2008–2016. An allergen panel containing Tabanus spp., Culicoides nubeculosus , mosquito (Culex spp.), Simulium equinum , and Stomoxys calcitrans was used. This study shows good agreement and correlation (correlation coefficient rho, 0.413–0.589) between the two tests for four (Tabanus spp, Culicoides nubeculosus , Culex spp., Simulium equinum) of the five tested allergens in horses with IBH. The overall sensitivity (Se) of the allergen-specific IgE insect horse panel was 72.6% (range, 30.8%–91.3%), the specificity (Sp) was 63.6% (range, 50%–70.1%), and the accuracy (Acc) was 73.3% (range, 48%–88.5%) compared with IDTs. This study found good agreement and correlation between IDTs and serological MASTs based on monoclonal antibodies for most of the determined allergens for horses with IBH. Highlights • New serological techniques in equine veterinary allergy testing and in vivo intradermal test in horses with insect bite hypersensitivity were compared. • Immunoenzymatic multiple allergen simultaneous test shows good correlation with intradermal test for Tabanus spp, Culicoides nubeculosus , Culex spp., and Simulium equinum. • Multiple allergen simultaneous test has a moderate accuracy, high sensitivity, and moderate specificity for diagnosing insect sensitization in horses. • Multiple simultaneous allergen test can be used in the causative diagnosis of insect allergy to select the relevant allergens for specific immunotherapy. [ABSTRACT FROM AUTHOR]

Intradermal tests (IDTs) and measurement of specific immunoglobulin E class (sIgE) levels in sera are the most common and reliable methods used in allergological clinical practice. The purpose of this study was to explore the sensitization of pollen allergy in atopic horses with pollinosis and to assess the diagnostic value of the multiple allergen simultaneous tests (MASTs) compared with that of the IDT. Twenty-one Malopolski horses with typical skin hypersensitivity symptoms during pollen seasons were enrolled. Intradermal tests were performed, and allergen-specific IgE concentrations in sera were measured using a monoclonal anti-IgE antibody to pollens of grass, weeds, trees, and cultivated plants. The highest sensitization rate was for Secale cereale (IDT, 76%; MAST, 66.7%), grass (IDT, 71%; MAST, 57%), and Brassica napus (IDT, 52.4%; MAST, 57%). Receiver operating characteristic (ROC) curve analysis and the area under the ROC curve (AUC) showed that Betula spp., Alnus spp., and Corylus spp. had the highest AUC at 0.854, followed by Secale cereal e (AUC = 0.796), Plantago lanceolata (AUC = 0.726), Brassica napus (AUC = 0.704), and a grass allergen mixture (AUC = 0.695). The mean AUC for all allergens was 0.712 (0.604–0.867). The overall sensitivity of the sIgE plant horse panel was 78% (range, 68%–90%), the specificity was 86.3% (range, 64%–100%), and the accuracy was 79% (range, 64%–87%). Statistical kappa (κ) agreement between the MAST and IDT was reached for tree (κ = 0.767), rye (κ = 0.687), colza (κ = 0.671), and grass (κ = 0.664) pollen. The MAST showed a favorable agreement with the IDT and can be used for the detection of sIgE in atopic horses with pollinosis. • Plant pollens are one of the most common triggers of seasonal allergies. • Intradermal tests and serological tests are reliable methods used in allergological clinical practice. • Multiple allergen simultaneous tests as a modern diagnostic technique can be used in specific IgE determination. • Atopic horses similar to humans and other species of animals are polysensitized to plant allergens. • Cultivated plant, tree, and grass pollens had a higher sensitization rate. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis-associated brain dysfunction is a common organ dysfunction in sepsis. The main goal of this study was to verify whether the combined assessment of central nervous system injury markers (i.e. S100B, NSE, GFAP) and disease severity as per the Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score II (SAPS II), and Sequential Organ Failure Assessment (SOFA) classification systems, would increase the accuracy of death prediction in septic shock., Material and Methods: Markers of neuronal damage were determined in 55 patients diagnosed with septic shock with no previous neurological disease. Clinical data was collected and the scores on the APACHE II, SAPS II and SOFA prognostic scales were calculated. Death before discharge from the Intensive Care Unit (ICU) was established as the endpoint., Results: Nineteen patients (35%) died before ICU discharge. Patients who died had significantly higher S100B and NSE values, and APACHE II, SAPS II and SOFA scores (P< 0.05 for all). At the time of septic shock diagnosis, NSE levels more accurately predicted the risk of death before ICU discharge than S100B. However, NSE had no better predictive value for short-term mortality than APACHE II, SAPS II and SOFA. Adding C-reactive protein (CRP) and S100B concentrations to the APACHE II score created a predictive model with 95% mortality accuracy (AUC = 0.95; 95%CI 0.85-0.99; P = 0.03)., Conclusions: The assessment of acute neuronal injury plays an important role in prognostication in patients with septic shock. The concentration of S100B protein in combination with APACHE II score and concentration of CRP more accurately predicts mortality than the APACHE II alone.