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Procalcitonin levels in gram-positive, gram-negative, and fungal bloodstream infections.

Leli C, Ferranti M, Moretti A, Al Dhahab ZS, Cenci E, Mencacci A - Dis. Markers (2015)

Bottom Line: Receiver operating characteristic analysis showed an area under the curve (AUC) for PCT of 0.765 (95% CI 0.725-0.805, P < 0.0001) in discriminating Gram-negatives from Gram-positives at the best cut-off value of 10.8 ng/mL and an AUC of 0.944 (95% CI 0.919-0.969, P < 0.0001) in discriminating Gram-negatives from fungi at the best cut-off of 1.6 ng/mL.Additional results showed a significant difference in median PCT values between Enterobacteriaceae and nonfermentative Gram-negative bacteria (17.1 ng/mL, IQR 5.9-48.5 versus 3.5 ng/mL, IQR 0.8-21.5; P < 0.0001).Nevertheless, its utility to predict different microorganisms needs to be assessed in further studies.

View Article: PubMed Central - PubMed

Affiliation: Microbiology Section, Department of Experimental Medicine, University of Perugia, 06100 Perugia, Italy.

ABSTRACT
Procalcitonin (PCT) can discriminate bacterial from viral systemic infections and true bacteremia from contaminated blood cultures. The aim of this study was to evaluate PCT diagnostic accuracy in discriminating Gram-positive, Gram-negative, and fungal bloodstream infections. A total of 1,949 samples from patients with suspected bloodstream infections were included in the study. Median PCT value in Gram-negative (13.8 ng/mL, interquartile range (IQR) 3.4-44.1) bacteremias was significantly higher than in Gram-positive (2.1 ng/mL, IQR 0.6-7.6) or fungal (0.5 ng/mL, IQR 0.4-1) infections (P < 0.0001). Receiver operating characteristic analysis showed an area under the curve (AUC) for PCT of 0.765 (95% CI 0.725-0.805, P < 0.0001) in discriminating Gram-negatives from Gram-positives at the best cut-off value of 10.8 ng/mL and an AUC of 0.944 (95% CI 0.919-0.969, P < 0.0001) in discriminating Gram-negatives from fungi at the best cut-off of 1.6 ng/mL. Additional results showed a significant difference in median PCT values between Enterobacteriaceae and nonfermentative Gram-negative bacteria (17.1 ng/mL, IQR 5.9-48.5 versus 3.5 ng/mL, IQR 0.8-21.5; P < 0.0001). This study suggests that PCT may be of value to distinguish Gram-negative from Gram-positive and fungal bloodstream infections. Nevertheless, its utility to predict different microorganisms needs to be assessed in further studies.

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Receiver operating characteristic (ROC) curves of different cut-offs of PCT in differentiating: (a) Gram-negative bacteria from Gram-positive bacteria (AUC 0.765, 95% CI 0.725–0.805; P < 0.0001); (b) Gram-negative bacteria from fungi (AUC 0.944, 95% CI 0.919–0.969, P < 0.0001); (c) Gram-positive bacteria from fungi (AUC 0.763, 95% CI 0.693–0.832; P < 0.0001). Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Positive Likelihood Ratio (+LR), and Negative Likelihood Ratio (−LR) are reported for the best cut-off values found in each ROC.
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fig2: Receiver operating characteristic (ROC) curves of different cut-offs of PCT in differentiating: (a) Gram-negative bacteria from Gram-positive bacteria (AUC 0.765, 95% CI 0.725–0.805; P < 0.0001); (b) Gram-negative bacteria from fungi (AUC 0.944, 95% CI 0.919–0.969, P < 0.0001); (c) Gram-positive bacteria from fungi (AUC 0.763, 95% CI 0.693–0.832; P < 0.0001). Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Positive Likelihood Ratio (+LR), and Negative Likelihood Ratio (−LR) are reported for the best cut-off values found in each ROC.

Mentions: To evaluate the PCT diagnostic accuracy in predicting causative organisms of bloodstream infections, ROC analysis was performed in monomicrobial BCs (Figure 2). The best diagnostic accuracy in discriminating Gram-negative from Gram-positive infections was at the cut-off value of 10.8 ng/mL, Gram-negative from fungal infections at 1.6 ng/mL, and Gram-positive from fungal infections at 1.3 ng/mL. The best values were found in discriminating Gram-negative or Gram-positive bacteria from fungi (Figure 2).


Procalcitonin levels in gram-positive, gram-negative, and fungal bloodstream infections.

Leli C, Ferranti M, Moretti A, Al Dhahab ZS, Cenci E, Mencacci A - Dis. Markers (2015)

Receiver operating characteristic (ROC) curves of different cut-offs of PCT in differentiating: (a) Gram-negative bacteria from Gram-positive bacteria (AUC 0.765, 95% CI 0.725–0.805; P < 0.0001); (b) Gram-negative bacteria from fungi (AUC 0.944, 95% CI 0.919–0.969, P < 0.0001); (c) Gram-positive bacteria from fungi (AUC 0.763, 95% CI 0.693–0.832; P < 0.0001). Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Positive Likelihood Ratio (+LR), and Negative Likelihood Ratio (−LR) are reported for the best cut-off values found in each ROC.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4380090&req=5

fig2: Receiver operating characteristic (ROC) curves of different cut-offs of PCT in differentiating: (a) Gram-negative bacteria from Gram-positive bacteria (AUC 0.765, 95% CI 0.725–0.805; P < 0.0001); (b) Gram-negative bacteria from fungi (AUC 0.944, 95% CI 0.919–0.969, P < 0.0001); (c) Gram-positive bacteria from fungi (AUC 0.763, 95% CI 0.693–0.832; P < 0.0001). Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Positive Likelihood Ratio (+LR), and Negative Likelihood Ratio (−LR) are reported for the best cut-off values found in each ROC.
Mentions: To evaluate the PCT diagnostic accuracy in predicting causative organisms of bloodstream infections, ROC analysis was performed in monomicrobial BCs (Figure 2). The best diagnostic accuracy in discriminating Gram-negative from Gram-positive infections was at the cut-off value of 10.8 ng/mL, Gram-negative from fungal infections at 1.6 ng/mL, and Gram-positive from fungal infections at 1.3 ng/mL. The best values were found in discriminating Gram-negative or Gram-positive bacteria from fungi (Figure 2).

Bottom Line: Receiver operating characteristic analysis showed an area under the curve (AUC) for PCT of 0.765 (95% CI 0.725-0.805, P < 0.0001) in discriminating Gram-negatives from Gram-positives at the best cut-off value of 10.8 ng/mL and an AUC of 0.944 (95% CI 0.919-0.969, P < 0.0001) in discriminating Gram-negatives from fungi at the best cut-off of 1.6 ng/mL.Additional results showed a significant difference in median PCT values between Enterobacteriaceae and nonfermentative Gram-negative bacteria (17.1 ng/mL, IQR 5.9-48.5 versus 3.5 ng/mL, IQR 0.8-21.5; P < 0.0001).Nevertheless, its utility to predict different microorganisms needs to be assessed in further studies.

View Article: PubMed Central - PubMed

Affiliation: Microbiology Section, Department of Experimental Medicine, University of Perugia, 06100 Perugia, Italy.

ABSTRACT
Procalcitonin (PCT) can discriminate bacterial from viral systemic infections and true bacteremia from contaminated blood cultures. The aim of this study was to evaluate PCT diagnostic accuracy in discriminating Gram-positive, Gram-negative, and fungal bloodstream infections. A total of 1,949 samples from patients with suspected bloodstream infections were included in the study. Median PCT value in Gram-negative (13.8 ng/mL, interquartile range (IQR) 3.4-44.1) bacteremias was significantly higher than in Gram-positive (2.1 ng/mL, IQR 0.6-7.6) or fungal (0.5 ng/mL, IQR 0.4-1) infections (P < 0.0001). Receiver operating characteristic analysis showed an area under the curve (AUC) for PCT of 0.765 (95% CI 0.725-0.805, P < 0.0001) in discriminating Gram-negatives from Gram-positives at the best cut-off value of 10.8 ng/mL and an AUC of 0.944 (95% CI 0.919-0.969, P < 0.0001) in discriminating Gram-negatives from fungi at the best cut-off of 1.6 ng/mL. Additional results showed a significant difference in median PCT values between Enterobacteriaceae and nonfermentative Gram-negative bacteria (17.1 ng/mL, IQR 5.9-48.5 versus 3.5 ng/mL, IQR 0.8-21.5; P < 0.0001). This study suggests that PCT may be of value to distinguish Gram-negative from Gram-positive and fungal bloodstream infections. Nevertheless, its utility to predict different microorganisms needs to be assessed in further studies.

Show MeSH
Related in: MedlinePlus