All You Need to Know About Sepsis, Causes, Diagnosis and Prevention
September 4, 2020
Diabetes In A Nutshell
November 6, 2020

Lab Talk

From the Editor...

September 13th is World Sepsis Day and at ISN, we are taking this opportunity to spread awareness on this disease and advise Healthcare Practitioners and patients on how they can prevent, diagnose and manage this sometimes fatal disease.

In this edition of Lab Talk, you will find important information related to the prevention, accurate diagnosis, and effective management of Sepsis. You will also learn about the clinical relevance of Procalcitonin (PCT) test, the effectiveness of the Phoenix M50 for quickly identifying the source of infection, and how by employing the right set of tools and equipment, the mortality rates from Sepsis can be drastically reduced.

We hope you enjoy this newsletter and that you make Lab Talk a regular part of your professional reading list. For more information about how you can access future editions of ISN’s Lab Talk, visit our website at www.isnmedical.com or contact our customer care department at 0800CALLISN (08002255476) or email us at customer@isnmedical.com.

In This Issue

  • From the Editor...
  • Clinical relevance of Procalcitonin (PCT) test in the management of Sepsis
  • Did you know...
  • Product in focus: The BD Phoenix M50
  • Doctor’s Corner
  • Featured Case Study: New Hope Hospitals and Laboratories Limited

CLINICAL RELEVANCE OF PROCALCITONIN (PCT) TEST IN THE MANAGEMENT OF SEPSIS

According to an article in the International Journal of Medical Sciences, an estimated 18 million cases are registered each year with a mortality rate of 30%. The increasing incidence of Sepsis as well as the costs associated with managing it make accurate diagnosis and aggressive treatment a priority across healthcare systems worldwide.

While blood culture is the primary method of identification, identification of the organism that is actually causing the infection is often a difficult task for many healthcare practitioners. The use of biomarkers is proving increasingly useful in accurate diagnosis of Sepsis with Procalcitonin (PCT) emerging as the leading parameter in this area.

As a sensitive and specific biomarker of the inflammatory response to bacterial infection, PCT aids clinicians in determining a patient’s risk of progression to sepsis and septic shock. It can take nearly 24 hours of appropriate antibiotic therapy to see reduction in plasma PCT levels as the bacterial infection is controlled, which will be reflected in a decrease in PCT production and circulating concentrations by up to 50% per day. However, if initial antibiotic therapy or source control is not adequate, bacteria will continue to stimulate PCT production and blood concentrations will remain high.

To find out how you can order the Elecsys BRAHMS Procalcitonin (PCT) solution for your laboratory, contact us at customer@isnmedical.com or talk to your ISN relationship manager.

Sources:
  1. www.roche.com
  2. International Journal of Medical Sciences 2020; 17(3): 332-337. doi: 10.7150/ijms.39367

Did you know...

  • Sepsis is the primary cause of death from infection.
  • Sepsis causes more deaths than prostate cancer, breast cancer and HIV/AIDS combined.
  • In the developing world, sepsis accounts for 60 to 80 percent of lost lives per year in childhood.
  • Patients surviving sepsis have twice the risk of death in the subsequent five years compared with the natural history of HBV and to monitor therapy.
  • Sepsis is associated with a mortality rate of 25–30% and mortality due to septic shock is 50–85%
  • Rapid intervention for sepsis can halve the risk of dying. Current guidelines recommend starting antibiotic therapy within one hour of identification of septic shock. Every hour delay is associated with a 6% rise in mortality.
  • Sepsis can result from a variety of types of infections: bacterial, fungal, or viral. The most common cause is bacterial.
Sources:
  1. Beckershospitalreview.com/quality/10-facts-for-world-sepsis-day.
  2. Scandinavian Journal of Trauma Resuscitation and Emergency Medicine v.27; 2019
Doctor’s Corner....

The symptoms of sepsis vary according to the stage of the medical condition. As such, the symptoms of severe sepsis or septic shock are much more foreboding (e.g., patches of discolored skin, changes in mental ability, problems with breathing, extreme weakness, etc.) than those for the initial stage of sepsis (e.g., a fever, an accelerated heart rate, an elevated level of breathing, nausea and vomiting, diarrhea, etc.) Recognizing the symptoms of sepsis is further complicated by the fact that sepsis can begin in different parts of the body and, therefore, can entail different symptoms.

Treating septic patients early is the single most important factor in their care. As such, the first 6 hours when an individual with sepsis shows up at the hospital are critical. The earlier a person with this rare, but deadly, condition is treated, the more likely the individual will survive.

The initial step to treat sepsis successfully is to diagnose the condition quickly. If sepsis is found to be present, a number of medications will be prescribed. Subsequently, once the infectious agent in the person has been identified, drugs that target that particular agent will be used. On occasion, if the sepsis has advanced to the point of heightened se- verity, other types of treatment (e.g., kidney dialysis or a breathing ma- chine) may need to be used.

With the Phoenix M50 Automated Identification and Susceptibility System from BD, you can now detect specific infection causing bacteria with recommendations on the appropriate antibiotic to use in less than 24 hours.

The future of sepsis, as a medical concern, is trending in a positive direction. Although sepsis remains a very serious problem, efforts to diagnose and treat this condition have improved. As a result, mortality rates for this terrible form of infection have dropped dramatically in the last two decades.

Source:
  1. ACSM's Health & Fitness Journal: July/ August 2014 - Volume 18 - Issue 4 - p 54

PRODUCT IN FOCUS

The BD Phoenix m50 Automated Identification and Susceptibility System

The BD PhoenixTM M50 is the ideal system for accurate and timely detection of organisms that cause sepsis. It is easy to use and provides reliable results; provides Clinicians with accurate and timely identification and susceptibility results to help guide their therapy and patient management decisions.

The system provides rapid identification and susceptibility testing of most clinically significant Gram-negative and Gram-positive bacteria, as well as yeast. In addition to detecting notable organisms that cause sepsis such as Pseudomonas aeruginosa, Candida albicans, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae and Proteus spp, the BD Phoenix M50 system panels test for several resistance markers such as:

  • Methicillin Resistant Staphylococcus aureus (MRSA)
  • Extended Spectrum Beta-lactamase (ESBL)
  • Carbapenemase Producing Organism (CPO)
  • Inducible Clindamycin Resistance (iMLSb)

The BD Phoenix CPO detect test is a unique test and is currently the only phenotypic test on an automated AST system that provides CPO detection and Ambler classification. On average, the BD Phoenix CPO detect test detects and classifies CPOs from isolated colonies within 6 to 11 hours.

For trusted performance, the BD PhoenixTM M50 utilizes on-panel doubling dilutions of antimicrobial concentrations for determination of MIC results. The BD Phoenix M50 instrument employs a delayed growth algorithm that may defer reporting for slow-growing organisms until additional instrument readings are collected.

Unique Design - The system is modular and scalable, it offers a compact and stackable design (up to two instruments) that allows for increased testing volumes by doubling capacity within the same footprint. The system is also easy to use as it requires minimal maintenance, no reagent additions post inoculation and few supplemental tests for final result determination, and utilizes leak-resistant, room-temperature panel storage.

References

FEATURED CASE STUDY: Enabling the Diagnosis of Sepsis at New Hope Hospital, Onitsha, Anambra

New hope Hospitals and Laboratory Limited is one of the largest health-care facilities located at the heart of Onitsha, in Anambra state. Since its establishment in 1984, New hope has established itself as a reliable point of call for accessible, quality and cost-effective health care in its region.

In keeping with its mission of providing high quality yet cost-effective health care in a conducive environment that promotes speedy recovery, New Hope Hospitals and Laboratory Limited has expanded its operations to about four sites across Onitsha, serving its patients and clients through a wide variety of qualified medical staff.

One of these sites is the renowned Onitsha Medical Diagnostic Centre Limited, located at 26 Umunna Street, Onitsha. Their commitment to ensuring quality and efficiency in medical diagnostics at this facility is highly evident in the wide array of top-level automated instruments being utilized in the laboratory. With an aim to fully equip their lab for Blood Culture, Identification and Susceptibility testing, Onitsha Medical Diagnostic Centre turned to ISN for the BD BACTEC FX40 and BD Phoenix M50.

The BD BACTEC FX40 is a blood culture instrument which builds on proven superior fluorescence detection technology, allowing for proper diagnosis and treatment of bloodstream infections.

The BD Phoenix M50 is an identification and suscepti- bility instrument which provides clinicians with accu- rate and timely results to help guide their therapy and patient management decisions.

The decision to invest in the BD BACTEC FX40 blood culture instrument arose due to the lengthy turnaround time of the manual method of Blood Culture testing. Rapid and accurate blood culture diagnosis - which is the gold standard for the microbiological diagnosis of sepsis - is of utmost importance for patients with suspected sepsis. According to laboratory manager, Mr. Chibueze, the FX-40 enables him to run blood culture tests within a shorter, 24-hour turnaround time.

It has been proven that knowledge of the causing bacteria or fungi and their susceptibility against antimicrobials enables the clinician to dispense the appropriate antimicrobial therapy. The BD Phoenix M50 provides accurate and timely identification and susceptibility results by providing clinicians with knowledge of the causing bacteria or fungi and their susceptibility against antimicrobials. This in turn enables the clinician to dispense the appropriate antimicrobial therapy, saving cost, time and in many cases, the patient’s life.

In the words of Mr. Chibueze, “Of course, the results from the instruments (BD BACTEC FX40 and BD Phoenix M50) have helped us to provide accurate test results for patients with sepsis especially children, that is, samples from pediatric centres, the elderly and diabetic patients. These are the most frequent positive cases we encounter. Once you have identified the causative organisms, treatment becomes much easier for the doctor and the patient.”

Ref: https://www.bd.com/resource.aspx?IDX=23899

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