Clinical value of procalcitonin for suspected nosocomial bloodstream infection

Abstract

Background/AimsProcalcitonin (PCT) may prove to be a useful marker to exclude or predict bloodstream infection (BSI). However, the ability of PCT levels to differentiate BSI from non-BSI episodes has not been evaluated in nosocomial BSI.MethodsWe retrospectively reviewed the medical records of patients ≥ 18 years of age with suspected BSI that developed more than 48 hours after admission.ResultsOf the 785 included patients, 105 (13.4%) had BSI episodes and 680 (86.6%) had non-BSI episodes. The median serum PCT level was elevated in patients with BSI as compared with those without BSI (0.65 ng/mL vs. 0.22 ng/mL, p = 0.001). The optimal PCT cut-off value of BSI was 0.27 ng/mL, with a corresponding sensitivity of 74.6% (95% confidence interval [CI], 66.4% to 81.7%) and a specificity of 56.5% (95% CI, 52.7% to 60.2%). The area under curve of PCT (0.692) was significantly larger than that of C-reactive protein (CRP; 0.526) or white blood cell (WBC) count (0.518). However, at the optimal cut-off value, PCT failed to predict BSI in 28 of 105 cases (26.7%). The PCT level was significantly higher in patients with an eGFR < 60 mL/min/1.73 m2 than in those with an eGFR ≥ 60 mL/min/1.73 m2 (0.68 vs. 0.17, p = 0.01).ConclusionsPCT was more useful for predicting nosocomial BSI than CRP or WBC count. However, the diagnostic accuracy of predicting BSI remains inadequate. Thus, PCT is not recommended as a single diagnostic tool to avoid taking blood cultures in the nosocomial setting.

The impact of procalcitonin to C-reactive protein ratio (PCR) kinetics as a predictor of mortality in nosocomial bloodstream infections

“…They have been used for early detection of infection and directing antibiotic therapy [8]. PCT level was higher in patients with nosocomial BSI and was more useful for predicting nosocomial BSI than CRP or white blood cell count [4]. PCT change faster than CRP in response to bacterial infection, and proper antibiotic therapy is associated with a rapid decrease in PCT levels [25].…”

“…The structure of nosocomial infections is dynamic and complex and often involves a large number of variables that adversely affect clinical outcomes [1]. Bloodstream infections (BSIs) in hospitalized patients are the leading cause of morbidity and mortality, and their early diagnosis and appropriate treatment is critical for positive outcome [2][3][4].…”

Biomarkers in Sepsis: Value of Procalcitonin in Diagnosis and Prognostication

“…Nishikawa et al used the same cut-off level and found that the area under curve of PCT in diagnosing bacteremia was larger than that of CRP (0.79 vs 0.66, respectively) [8]. Cha et al indicated that PCT levels should not be used as a sole diagnostic for sepsis without blood cultures, evidenced by inability to rule out one-fourth of those with nosocomial sepsis when a PCT cut-off level of 0.27 ng/mL was used [9].…”

Procalcitonin levels in children with bloodstream infections caused by different species: a cohort study

“…High levels of PCT are observed in critically-ill infected patients (7)(8)(9)(10). It has been reported that elevated PCT levels predict blood culture-con rmed bacteremia in adults, with a 75% sensitivity and 72% speci city (9).…”