Limits...
Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria.

Charles PE, Ladoire S, Aho S, Quenot JP, Doise JM, Prin S, Olsson NO, Blettery B - BMC Infect. Dis. (2008)

Bottom Line: However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result.Moreover, in the study population, a high PCT value was found to be independently associated with GN bacteremia.In a critically ill patient with clinical sepsis, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia, regardless of the severity of the disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service de Réanimation Médicale, Hôpital Le Bocage, C.H.U. de DIJON, France. pierre-emmanuel.charles@chu-dijon.fr

ABSTRACT

Background: In the ICU, bacteremia is a life-threatening infection whose prognosis is highly dependent on early recognition and treatment with appropriate antibiotics. Procalcitonin levels have been shown to distinguish between bacteremia and noninfectious inflammatory states accurately and quickly in critically ill patients. However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result.

Methods: Review of the medical records of every patient treated between May, 2004 and December, 2006 who had bacteremia caused by either Gram positive (GP) or Gram negative (GN) bacteria, and whose PCT dosage at the onset of infection was available.

Results: 97 episodes of either GN bacteremia (n = 52) or GP bacteremia (n = 45) were included. Procalcitonin levels were found to be markedly higher in patients with GN bacteremia than in those with GP bacteremia, whereas the SOFA score value in the two groups was similar. Moreover, in the study population, a high PCT value was found to be independently associated with GN bacteremia. A PCT level of 16.0 ng/mL yielded an 83.0% positive predictive value and a 74.0% negative predictive value for GN-related bacteremia in the study cohort (AUROCC = 0.79; 95% CI, 0.71-0.88).

Conclusion: In a critically ill patient with clinical sepsis, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia, regardless of the severity of the disease.

Show MeSH

Related in: MedlinePlus

Serum procalcitonin (PCT) level (Fig. A), white blood cell count (WBC) (Fig. B) and C-reactive protein (CRP) level (Fig. C), at the onset of bacteremia caused by either gram negative (left boxes, GN; n = 52) or gram positive (right boxes, GP; n = 45) species in critically ill patients with clinical sepsis. Data are presented as box plots with median lines, 25- and 75-percentile boxes, and 10- and 90-percentile error bars. The circles represent the outliers. A log scale is used for the Y-axis in the Fig. A. * indicate p < 0.05 between GP and GN bacteremia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2289831&req=5

Figure 1: Serum procalcitonin (PCT) level (Fig. A), white blood cell count (WBC) (Fig. B) and C-reactive protein (CRP) level (Fig. C), at the onset of bacteremia caused by either gram negative (left boxes, GN; n = 52) or gram positive (right boxes, GP; n = 45) species in critically ill patients with clinical sepsis. Data are presented as box plots with median lines, 25- and 75-percentile boxes, and 10- and 90-percentile error bars. The circles represent the outliers. A log scale is used for the Y-axis in the Fig. A. * indicate p < 0.05 between GP and GN bacteremia.

Mentions: Serum PCT levels at the time of bacteremia onset were markedly greater in the GN group than in the GP group (71.27 [116.42], median = 39.00 [range: 0.41–746.0] and 16.85 [37.34], median = 5.42 [range: 0.07–169.00] ng/mL, respectively; p = 0.003) (Figure 1). In contrast, the CRP values as well as the WBC in the two groups were similar. Very low levels of PCT (i.e., below the 0.5 ng/mL threshold) were found in 6 patients. Interestingly, bacteremia was caused by a GP bacteria in 5 of them. In addition, the source of infection was "superficial" (i.e., soft tissues or catheter) or unknown in all but one cases.


Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria.

Charles PE, Ladoire S, Aho S, Quenot JP, Doise JM, Prin S, Olsson NO, Blettery B - BMC Infect. Dis. (2008)

Serum procalcitonin (PCT) level (Fig. A), white blood cell count (WBC) (Fig. B) and C-reactive protein (CRP) level (Fig. C), at the onset of bacteremia caused by either gram negative (left boxes, GN; n = 52) or gram positive (right boxes, GP; n = 45) species in critically ill patients with clinical sepsis. Data are presented as box plots with median lines, 25- and 75-percentile boxes, and 10- and 90-percentile error bars. The circles represent the outliers. A log scale is used for the Y-axis in the Fig. A. * indicate p < 0.05 between GP and GN bacteremia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2289831&req=5

Figure 1: Serum procalcitonin (PCT) level (Fig. A), white blood cell count (WBC) (Fig. B) and C-reactive protein (CRP) level (Fig. C), at the onset of bacteremia caused by either gram negative (left boxes, GN; n = 52) or gram positive (right boxes, GP; n = 45) species in critically ill patients with clinical sepsis. Data are presented as box plots with median lines, 25- and 75-percentile boxes, and 10- and 90-percentile error bars. The circles represent the outliers. A log scale is used for the Y-axis in the Fig. A. * indicate p < 0.05 between GP and GN bacteremia.
Mentions: Serum PCT levels at the time of bacteremia onset were markedly greater in the GN group than in the GP group (71.27 [116.42], median = 39.00 [range: 0.41–746.0] and 16.85 [37.34], median = 5.42 [range: 0.07–169.00] ng/mL, respectively; p = 0.003) (Figure 1). In contrast, the CRP values as well as the WBC in the two groups were similar. Very low levels of PCT (i.e., below the 0.5 ng/mL threshold) were found in 6 patients. Interestingly, bacteremia was caused by a GP bacteria in 5 of them. In addition, the source of infection was "superficial" (i.e., soft tissues or catheter) or unknown in all but one cases.

Bottom Line: However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result.Moreover, in the study population, a high PCT value was found to be independently associated with GN bacteremia.In a critically ill patient with clinical sepsis, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia, regardless of the severity of the disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service de Réanimation Médicale, Hôpital Le Bocage, C.H.U. de DIJON, France. pierre-emmanuel.charles@chu-dijon.fr

ABSTRACT

Background: In the ICU, bacteremia is a life-threatening infection whose prognosis is highly dependent on early recognition and treatment with appropriate antibiotics. Procalcitonin levels have been shown to distinguish between bacteremia and noninfectious inflammatory states accurately and quickly in critically ill patients. However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result.

Methods: Review of the medical records of every patient treated between May, 2004 and December, 2006 who had bacteremia caused by either Gram positive (GP) or Gram negative (GN) bacteria, and whose PCT dosage at the onset of infection was available.

Results: 97 episodes of either GN bacteremia (n = 52) or GP bacteremia (n = 45) were included. Procalcitonin levels were found to be markedly higher in patients with GN bacteremia than in those with GP bacteremia, whereas the SOFA score value in the two groups was similar. Moreover, in the study population, a high PCT value was found to be independently associated with GN bacteremia. A PCT level of 16.0 ng/mL yielded an 83.0% positive predictive value and a 74.0% negative predictive value for GN-related bacteremia in the study cohort (AUROCC = 0.79; 95% CI, 0.71-0.88).

Conclusion: In a critically ill patient with clinical sepsis, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia, regardless of the severity of the disease.

Show MeSH
Related in: MedlinePlus