Accuracy of procalcitonin for diagnosing peripheral blood culture contamination among patients with positive blood culture for potential contaminants

Berthezène, Clémence; Aissa, Nejla; Manteaux, Anne Elisabeth; Guéant, Jean‐Louis; Oussalah, Abderrahim; Lozniewski, Alain

doi:10.1007/s15010-021-01697-4

Cited by 6 publications

(7 citation statements)

References 20 publications

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“…However, true bacteremias for classical contaminants are mainly observed among patients with healthcare-associated and hospital-acquired bloodstream infections rather than those with CA-BSIs [7]. Furthermore, we recently showed that patients with blood culture contamination had a plasma procalcitonin level of < 0.1 ng/mL [40]. Third, given the study design and the architecture of the Nancy Biochemical Database, we could not determine the nal diagnosis or the source of the infection in the patients included in the study.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Procalcitonin at Admission as a Risk-Stratifying Biomarker for 50-Day In- Hospital Mortality Among Patients with Community-Acquired Bloodstream Infection: An Observational Cohort Study

Oussalah

Callet

Manteaux

et al. 2022

Preprint

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Purpose: To assess the association between plasma procalcitonin concentration at hospital admission and the risk of 50-day in-hospital mortality among patients with community-acquired bloodstream infections. Methods: We carried out a retrospective, observational cohort study with all consecutive patients with bacteriologically confirmed community-acquired bloodstream infections hospitalized between 2006 and 2012. We aimed to assess the association between plasma procalcitonin at admission and 50-day in-hospital mortality. Patients were included in the analysis if they had undergone a blood culture test within 48 hours of hospitalization with a concomitant procalcitonin assay (time < 12 hours between the two tests). Inclusion in the study began on the day of hospital admission, and each patient was followed until death, discharge from hospital, or last known follow-up in the 50 days following hospital admission. The endpoint was the occurrence of all-cause in-hospital mortality during the 50 days following hospital admission. Results: During the 7-year study period, 1593 patients were admitted to one of the health care facilities of the University Hospital of Nancy from home or through the emergency department and had positive blood cultures and concomitant procalcitonin assays. Among the patients, 452 met the selection criteria and were analyzed. In ROC analysis, procalcitonin at baseline was significantly associated with 50-day in-hospital mortality, with an optimal threshold > 4.24 ng/mL. A baseline procalcitonin > 4.24 ng/mL was independently associated with an increased risk of in-hospital mortality (multivariable logistic regression: odds ratio, 2.58; 95% CI, 1.57–4.25; P = 0.0002; Cox proportional hazard regression: hazard ratio, 2.01; 95% CI, 1.30–3.11; P = 0.002). In sensitivity analyses, baseline procalcitonin quartiles were independently associated with 50-day in-hospital mortality (multivariable logistic regression: odds ratio, 1.47; 95% CI, 1.17–1.85; P = 0.001; Cox proportional hazard regression: hazard ratio, 1.31; 95% CI, 1.07–1.60; P = 0.008). The independent associations between baseline procalcitonin and the risk of 50-day in-hospital mortality were maintained after adjusting for C-reactive protein and sepsis status at admission. Conclusion:Our data provide the first evidence of the usefulness of plasma procalcitonin at admission as a risk-stratifying biomarker for predicting 50-day in-hospital mortality among patients with community-acquired bloodstream infections.

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Section: Discussionmentioning

confidence: 99%

Usefulness of Procalcitonin at Admission as a Risk-Stratifying Biomarker for 50-Day In- Hospital Mortality Among Patients with Community-Acquired Bloodstream Infection: An Observational Cohort Study

Oussalah

Callet

Manteaux

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, true bacteremias for classical contaminants are mainly observed among patients with healthcareassociated and hospital-acquired bloodstream infections rather than those with CA-BSIs [7]. Furthermore, we recently showed that patients with blood culture contamination had a plasma procalcitonin level of < 0.1 ng/mL [40]. Third, given the study design and the architecture of the Nancy Biochemical Database, we could not determine the final diagnosis or the source of the infection in the patients included in the study.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of procalcitonin at admission as a risk-stratifying biomarker for 50-day in-hospital mortality among patients with community-acquired bloodstream infection: an observational cohort study

Oussalah

Callet²,

Manteaux

et al. 2023

Biomark Res

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Purpose To assess the association between plasma procalcitonin concentration at hospital admission and the risk of 50-day in-hospital mortality among patients with community-acquired bloodstream infections. Methods We carried out a retrospective, observational cohort study with all consecutive patients with bacteriologically confirmed community-acquired bloodstream infections hospitalized between 2006 and 2012. We aimed to assess the association between plasma procalcitonin at admission and 50-day in-hospital mortality. Patients were included in the analysis if they had undergone a blood culture test within 48 hours of hospitalization with a concomitant procalcitonin assay (time < 12 hours between the two tests). Inclusion in the study began on the day of hospital admission, and each patient was followed until death, discharge from the hospital, or last known follow-up in the 50 days following hospital admission. The endpoint was the occurrence of all-cause in-hospital mortality during the 50 days following hospital admission. Results During the 7-year study period, 1593 patients were admitted to one of the healthcare facilities of the University Hospital of Nancy from home or through the emergency department and had positive blood cultures and concomitant procalcitonin assays. Among the patients, 452 met the selection criteria and were analyzed. In ROC analysis, procalcitonin at baseline was significantly associated with 50-day in-hospital mortality, with an optimal threshold > 4.24 ng/mL. A baseline procalcitonin > 4.24 ng/mL was independently associated with an increased risk of in-hospital mortality (multivariable logistic regression: odds ratio, 2.58; 95% CI, 1.57–4.25; P = 0.0002; Cox proportional hazard regression: hazard ratio, 2.01; 95% CI, 1.30–3.11; P = 0.002). In sensitivity analyses, baseline procalcitonin quartiles were independently associated with 50-day in-hospital mortality (multivariable logistic regression: odds ratio, 1.47; 95% CI, 1.17–1.85; P = 0.001; Cox proportional hazard regression: hazard ratio, 1.31; 95% CI, 1.07–1.60; P = 0.008). The independent associations between baseline procalcitonin and the risk of 50-day in-hospital mortality were maintained after adjusting for C-reactive protein and sepsis status at admission. Conclusion Our data provide the first evidence of the usefulness of plasma procalcitonin at admission as a risk-stratifying biomarker for predicting 50-day in-hospital mortality among patients with community-acquired bloodstream infections.

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“…One counterintuitive finding of this study was that those admitted because of infection had a diminished risk of contamination. This could be ascribed to heightened clinical alertness when managing infectious cases, with more stringent adherence to sterilization and procedural protocols [ 16 ]. Conversely, the microbial landscape of a patient during infection is dominated by pathogens, making it challenging for contaminants to thrive [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Blood Culture Contamination in Rural Hospitals in Japan: A Cross-Sectional Study

Ohta,

Sano

2023

Cureus

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Background Blood culture, a cornerstone diagnostic test, is paramount for identifying bacteremia due to serious infections. However, its accuracy is jeopardized by contamination, often due to inappropriate collection procedures. Resource constraints and a limitation in specialized staff can heighten contamination risks in rural hospitals, underscoring the need to understand the associated demographics and conditions. This study aimed to elucidate the demographics and conditions associated with heightened blood culture contamination risk in rural hospitals to optimize testing practices and improve patient care. Methods A single-center, cross-sectional study was conducted in Unnan City Hospital, Unnan, Japan with participants suspected of having bacteremia. Data from the electronic medical records of 455 patients were analyzed using multivariate logistic regression with contamination as the dependent variable. Results Of the 455 patients who underwent blood culture testing, 321 and 134 tests were negative and positive for contamination, respectively. Older age and blood obtained from arteries were associated with a reduced risk of contamination (odds ratio (OR)=0.97; p=0.012, and OR=0.17; p=0.00069, respectively). Patients with dependencies exhibited an increase in contamination risk (OR=1.81; p=0.044). Patients admitted for infection demonstrated a reduced likelihood of sample contamination (OR=0.44; p=0.0034). The predominant organisms identified varied, with Escherichia coli being more frequent in uncontaminated blood samples and Staphylococcus epidermidis in the contaminated samples. Conclusion This study reveals a complex relationship between patient demographics, clinical practices, and the risk of contamination. Factors such as age, dependency status, and reason for admission were associated with sample contamination. Enhanced procedural stringency, microbial surveillance, and continuous training could mitigate these risks, particularly in resource-constrained settings. Identifying and understanding the factors influencing blood culture contamination can significantly bolster clinical practice in rural settings. While this study provides foundational insights, future research can deepen our understanding, ensuring the refinement of patient care protocols in similar environments.

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Accuracy of procalcitonin for diagnosing peripheral blood culture contamination among patients with positive blood culture for potential contaminants

Cited by 6 publications

References 20 publications

Usefulness of Procalcitonin at Admission as a Risk-Stratifying Biomarker for 50-Day In- Hospital Mortality Among Patients with Community-Acquired Bloodstream Infection: An Observational Cohort Study

Usefulness of Procalcitonin at Admission as a Risk-Stratifying Biomarker for 50-Day In- Hospital Mortality Among Patients with Community-Acquired Bloodstream Infection: An Observational Cohort Study

Usefulness of procalcitonin at admission as a risk-stratifying biomarker for 50-day in-hospital mortality among patients with community-acquired bloodstream infection: an observational cohort study

Factors Associated With Blood Culture Contamination in Rural Hospitals in Japan: A Cross-Sectional Study

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