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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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Comparison of PCT median values in bloodstream infections by Enterobacteriaceae, non-fermentative Gram-negative bacteria, or obligate anaerobic Gram-negative bacteria.
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fig3: Comparison of PCT median values in bloodstream infections by Enterobacteriaceae, non-fermentative Gram-negative bacteria, or obligate anaerobic Gram-negative bacteria.

Mentions: Table 2 shows median PCT values corresponding to the different microbial species isolated in two or more patients with monomicrobial bacteremias, and Table 3 reports PCT values corresponding to pathogens isolated only in one patient or to polymicrobial infections. To evaluate the possibility that different PCT values could correspond to different microbial groups, PCT median values obtained in monomicrobial bloodstream infections by different species were compared. Among Gram-positives, median values found for Streptococcus pneumoniae or Staphylococcus aureus were significantly higher than those found for enterococci (0.8 ng/mL, IQR 0.4–2.3, and P = 0.001) or streptococci other than S. pneumoniae (1.4 ng/mL, IQR 0.3–3.9, and P = 0.005). No significant difference was found among different yeast species (data not shown). In bloodstream infections by Gram-negatives, PCT median value corresponding to Enterobacteriaceae (17.1 ng/mL, IQR 5.9–48.5) was significantly higher than that found for nonfermentative (3.5 ng/mL, IQR 0.8–21.5, and P < 0.0001) or obligate anaerobic bacteria (2.8 ng/mL, IQR 0.5–8.5, and P < 0.0001) (Figure 3). ROC analysis showed that the best cut-off for PCT in discriminating Enterobacteriaceae from nonfermentative Gram-negative bacteria was 3.1 ng/mL, with 90% sensitivity and 91% PPV (Figure 4).


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)

Comparison of PCT median values in bloodstream infections by Enterobacteriaceae, non-fermentative Gram-negative bacteria, or obligate anaerobic Gram-negative bacteria.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4380090&req=5

fig3: Comparison of PCT median values in bloodstream infections by Enterobacteriaceae, non-fermentative Gram-negative bacteria, or obligate anaerobic Gram-negative bacteria.
Mentions: Table 2 shows median PCT values corresponding to the different microbial species isolated in two or more patients with monomicrobial bacteremias, and Table 3 reports PCT values corresponding to pathogens isolated only in one patient or to polymicrobial infections. To evaluate the possibility that different PCT values could correspond to different microbial groups, PCT median values obtained in monomicrobial bloodstream infections by different species were compared. Among Gram-positives, median values found for Streptococcus pneumoniae or Staphylococcus aureus were significantly higher than those found for enterococci (0.8 ng/mL, IQR 0.4–2.3, and P = 0.001) or streptococci other than S. pneumoniae (1.4 ng/mL, IQR 0.3–3.9, and P = 0.005). No significant difference was found among different yeast species (data not shown). In bloodstream infections by Gram-negatives, PCT median value corresponding to Enterobacteriaceae (17.1 ng/mL, IQR 5.9–48.5) was significantly higher than that found for nonfermentative (3.5 ng/mL, IQR 0.8–21.5, and P < 0.0001) or obligate anaerobic bacteria (2.8 ng/mL, IQR 0.5–8.5, and P < 0.0001) (Figure 3). ROC analysis showed that the best cut-off for PCT in discriminating Enterobacteriaceae from nonfermentative Gram-negative bacteria was 3.1 ng/mL, with 90% sensitivity and 91% PPV (Figure 4).

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