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Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia
BACKGROUND: This study aimed to evaluate the accuracy of procalcitonin (PCT) serum concentrations to diagnose Gram-negative bacteremia and the association of PCT serum concentrations with more specific pathogens and the focus of infection. METHODS: Secondary analysis of the prospectively collected p...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949148/ https://www.ncbi.nlm.nih.gov/pubmed/29753321 http://dx.doi.org/10.1186/s13054-018-2050-9 |
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author | Thomas-Rüddel, Daniel O. Poidinger, Bernhard Kott, Matthias Weiss, Manfred Reinhart, Konrad Bloos, Frank |
author_facet | Thomas-Rüddel, Daniel O. Poidinger, Bernhard Kott, Matthias Weiss, Manfred Reinhart, Konrad Bloos, Frank |
author_sort | Thomas-Rüddel, Daniel O. |
collection | PubMed |
description | BACKGROUND: This study aimed to evaluate the accuracy of procalcitonin (PCT) serum concentrations to diagnose Gram-negative bacteremia and the association of PCT serum concentrations with more specific pathogens and the focus of infection. METHODS: Secondary analysis of the prospectively collected patient-level dataset from a cluster randomized quality improvement trial was performed. The trial included sepsis patients with organ dysfunction treated in the participating intensive care units from 2011 to 2015. Test performance for the prediction of Gram-negative bacteremia was assessed by receiver operating curve analysis. Independent effects of specific pathogen groups and foci of infection on PCT concentrations were assessed by linear logistic regression models. RESULTS: Blood cultures (BC) and PCT concentrations had been taken in 4858 of 6561 documented patients. PCT was significantly higher in Gram-negative bacteremia compared to Gram-positive bacteremia or candidemia (p < 0.001). The area under the curve was 0.72 (95% confidence interval 0.71–0.74) for the prediction of Gram-negative bacteremia compared to all other blood culture results including negative blood cultures. The optimized cutoff value was 10 ng/ml (sensitivity 69%, specificity 35%). PCT differed significantly between specific groups of pathogens (p < 0.001) with highest concentrations in Escherichia coli, Streptococcus species and other Enterobacteriaceae. PCT was highest in urogenital followed by abdominal infection and lowest in respiratory infection (p < 0.001). In a linear regression model, Streptococci, E. coli and other Enterobacteriaceae detected from BC were associated with three times higher PCT values. Urogenital or abdominal foci of infection were associated with twofold increased PCT values independent of the pathogen. CONCLUSIONS: Serum PCT concentrations are higher in patients with Gram-negative bacteremia than in patients with Gram-positive bacteremia or candidemia. However, the discriminatory power of this difference is too low to guide therapeutic decisions. Variations in PCT serum concentrations are not determined solely by Gram-negative or Gram-positive bacteria but are also affected by distinct groups of pathogens and different foci of infection. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01187134. Registered on 23 August 2010. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-018-2050-9) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5949148 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-59491482018-05-18 Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia Thomas-Rüddel, Daniel O. Poidinger, Bernhard Kott, Matthias Weiss, Manfred Reinhart, Konrad Bloos, Frank Crit Care Research BACKGROUND: This study aimed to evaluate the accuracy of procalcitonin (PCT) serum concentrations to diagnose Gram-negative bacteremia and the association of PCT serum concentrations with more specific pathogens and the focus of infection. METHODS: Secondary analysis of the prospectively collected patient-level dataset from a cluster randomized quality improvement trial was performed. The trial included sepsis patients with organ dysfunction treated in the participating intensive care units from 2011 to 2015. Test performance for the prediction of Gram-negative bacteremia was assessed by receiver operating curve analysis. Independent effects of specific pathogen groups and foci of infection on PCT concentrations were assessed by linear logistic regression models. RESULTS: Blood cultures (BC) and PCT concentrations had been taken in 4858 of 6561 documented patients. PCT was significantly higher in Gram-negative bacteremia compared to Gram-positive bacteremia or candidemia (p < 0.001). The area under the curve was 0.72 (95% confidence interval 0.71–0.74) for the prediction of Gram-negative bacteremia compared to all other blood culture results including negative blood cultures. The optimized cutoff value was 10 ng/ml (sensitivity 69%, specificity 35%). PCT differed significantly between specific groups of pathogens (p < 0.001) with highest concentrations in Escherichia coli, Streptococcus species and other Enterobacteriaceae. PCT was highest in urogenital followed by abdominal infection and lowest in respiratory infection (p < 0.001). In a linear regression model, Streptococci, E. coli and other Enterobacteriaceae detected from BC were associated with three times higher PCT values. Urogenital or abdominal foci of infection were associated with twofold increased PCT values independent of the pathogen. CONCLUSIONS: Serum PCT concentrations are higher in patients with Gram-negative bacteremia than in patients with Gram-positive bacteremia or candidemia. However, the discriminatory power of this difference is too low to guide therapeutic decisions. Variations in PCT serum concentrations are not determined solely by Gram-negative or Gram-positive bacteria but are also affected by distinct groups of pathogens and different foci of infection. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01187134. Registered on 23 August 2010. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-018-2050-9) contains supplementary material, which is available to authorized users. BioMed Central 2018-05-13 /pmc/articles/PMC5949148/ /pubmed/29753321 http://dx.doi.org/10.1186/s13054-018-2050-9 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Thomas-Rüddel, Daniel O. Poidinger, Bernhard Kott, Matthias Weiss, Manfred Reinhart, Konrad Bloos, Frank Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia |
title | Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia |
title_full | Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia |
title_fullStr | Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia |
title_full_unstemmed | Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia |
title_short | Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia |
title_sort | influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949148/ https://www.ncbi.nlm.nih.gov/pubmed/29753321 http://dx.doi.org/10.1186/s13054-018-2050-9 |
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