Diagnostic Accuracy of Procalcitonin for Differentiating Bacteraemic Gram-Negative Sepsis from Gram-Positive Sepsis

Bilgili, Beliz; Haliloğlu, Murat; Aslan, Melek Süzer; Sayan, İsmet; Kasapoğlu, Umut Sabri; Cinel, İsmail

doi:10.5152/tjar.2017.88965

Cited by 8 publications

(3 citation statements)

References 22 publications

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“…In our study, PCT in the CPSS group was significantly higher than that in the CNSS group. Several studies have indicated that PCT levels are significantly higher in adult patients with gram-negative sepsis than in adult patients with gram-positive sepsis (25)(26)(27)(28). However, in this study, subgroup analysis showed that there was no significant difference in PCT levels between gram-positive and gram-negative septic shock in children.…”

Section: Discussioncontrasting

confidence: 85%

Comparing outcomes between culture-positive and culture-negative septic shock in a PICU: A retrospective cohort study

et al. 2022

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BackgroundWe assessed the outcomes and characteristics of culture-negative septic shock (CNSS) and culture-positive septic shock (CPSS) in pediatric intensive care unit (PICU).MethodsWe performed a retrospective study on the data of children admitted to the PICU due to septic shock between January 2018 and December 2021. The primary outcome was in-hospital mortality. The secondary outcomes were the length of stay (LOS) of hospital, the need for mechanical ventilation (MV) and continue renal replacement therapy (CRRT).ResultsOverall, 238 patients were enrolled. 114 patients (47.9%) had positive cultures (60 blood samples, 41 sputum samples, 17 pus samples, and 19 others), 18 of whom were cultured positive at two sites, 1 at three sites, and 3 had two different types of bacteria at same site. The in-hospital mortality was 47.1%. There were no significant differences in the in-hospital mortality (47.6% vs. 46.5%, P = 0.866), PRISM-III score (10 vs. 12, P = 0.409), PIM-3 score (0.08 vs. 0.07, P = 0.845), pSOFA score (10 vs. 10, P = 0.677) or the need for MV (64.5% vs. 68.4%, P = 0.524) and CRRT (29.8% vs. 34.2%, P = 0.470) between the CNSS group and the CPSS group. The Procalcitonin (8.89 ng/ml vs. 28.39 ng/ml, P = 0.001) and C-reactive protein (28 mg/L vs. 58 mg/L, P = 0.001) levels were significantly lower in the CNSS group than in the CPSS group, while WBC count (9.03 × 109/L vs. 5.02 × 109/L, P = 0.002) and serum sodium (137 mmol/L vs. 132 mmol/L, P = 0.001) was significantly higher in CNSS. The LOS of hospital was significantly longer (16 days vs. 11 days, P = 0.011) in the CPSS group than in the CNSS group, while the LOS of PICU (5 days vs. 4 days, P = 0.094) stay was not significantly different.ConclusionCompared with children with CNSS, children with CPSS had higher PCT and CRP levels, but lower WBC count. Children with CPSS had longer LOS of hospital. However, positive or negative culture results were not associated with in-hospital mortality, the LOS of PICU, the need for MV or CRRT in children with septic shock.

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Section: Discussioncontrasting

confidence: 85%

Comparing outcomes between culture-positive and culture-negative septic shock in a PICU: A retrospective cohort study

et al. 2022

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“…The statistical analysis of PCT levels on the first day of microbiological identification in blood samples in this sample of extensively burned patients confirmed previous reports demonstrating significantly higher values in the presence of Gram-negative bacteria comparing with controls or patients with Gram-positive sepsis. [10][11][12][13] The difference was most pronounced when causative agents were glucose nonfermenting bacilli, particularly Acinetobacter and Pseudomonas spp., or Enterobacteriaceae rods, like E. coli or K. pneumoniae. On the other hand, a statistical difference in PCT levels was not found between in PCT levels of patients with sepsis caused by Gram-positive bacteria and control patients, with the exception of patients with sepsis caused by Streptococcus spp.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Procalcitonin Accuracy for the Distinction Between Gram-Negative and Gram-Positive Bacterial Sepsis in Burn Patients

Cabral

Afreixo

Meireles

et al. 2018

Journal of Burn Care &Amp; Research

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Sepsis is the main cause of death in burns. Early institution of antimicrobial therapy is crucial to optimize outcomes but superfluous therapy increases adverse events, microbial resistance, and costs. Blood cultures are the gold standard for diagnosis but can take 48 to 72 hours. Biomarkers are used to help sepsis diagnosis and distinction between Gram-negative and Gram-positive bacterial cause. The aim of this work is to evaluate procalcitonin (PCT) accuracy for this distinction in burn patients. Retrospective observational study of adult septic burn patients with ≥15% total burn surface area admitted from January 2011 to December 2014 at a Burn Unit in Portugal. A statistical analysis was done, evaluating the correlation between PCT levels on the day of the first positive blood culture and microbiological data for Gram-negative and Grand-positive bacteria. Patients with mixed bacterial and/or fungal blood cultures were excluded. Data were summarized by quartiles statistics. Blood cultures were positive in 189 patients: 75 (39.7%) showed growth for Gram-negative and 114 (60.3%) for Gram-positive bacteria. Patients with Gram-negative bacteria have significantly higher PCT levels. Receiver operating characteristic curve analysis showed accuracy for Gram-negative discrimination with area under the curve = 0.687. Most elevated levels were related to nonfermentative Gram-negative bacteria and by Klebsiella pneumoniae and other Enterobacteriaceae. PCT levels were significantly higher in burn patients with Gram-negative sepsis comparing to patients with Gram-positive sepsis and controls. The determination of PCT levels may help the choice of empirical antimicrobial therapy while microbiological culture results are not available, despite not fully ensuring the desirable degree of precision. An early and adequate antimicrobial therapy is the main step for the management of septic patients. 1 Unfortunately, differential diagnosis between sepsis and the systemic inflammatory response triggered by trauma is difficult, particularly in burn patients where the usual clinical signs of sepsis are frequently present even in the absence of microbial infection. 2 For instance, burn injuries leading to upregulation of the hypothalamic thermal center, physiologic release of catecholamines and cytokines, shift of fluids and the consequent cardiovascular changes, can produce hyperthermia, tachycardia, hypotension, etc., that are transitory and do not reflect any microbial invasion but just a tentative of adjustment of human body systems to the changes in the homeostatic equilibrium.

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“…Kan kültürü üremesi için PCT eşik değeri 3.29 olarak belirlendi ve PCT'nin bakteriyemiyi ayırt etme yeteneğinin orta düzeyde olduğu (%70-%80) tespit edildi. Eş zamanlı antibiyotik kullanımı, yavaş üreyen veya kültürde üremeye uygun olmayan patojenlerin varlığı gibi nedenlerle sepsis hastalarının %30'unda kan kültürünün negatif olarak sonuçlanabileceği bildirilmiştir (6). Çalışmamızda da PCT değeri çok yüksek olduğu halde kan kültürlerinde üreme olmayan hastalar mevcuttu.…”

Section: Bulgularunclassified

Is Procalcitonin a Valid Biomarker for Bacteremia in Patients Presenting to the Emergency Department?

Çelik-Ekinci

2023

Klimik Derg

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Diagnostic Accuracy of Procalcitonin for Differentiating Bacteraemic Gram-Negative Sepsis from Gram-Positive Sepsis

Abstract: Patients with gram-negative sepsis had higher PCT values than those with gram-positive sepsis. Our results suggest that PCT value may be a useful tool for distinguishing between gram-negative and gram-positive bacteraemia.

Cited by 8 publications

References 22 publications

Comparing outcomes between culture-positive and culture-negative septic shock in a PICU: A retrospective cohort study

Comparing outcomes between culture-positive and culture-negative septic shock in a PICU: A retrospective cohort study

Evaluation of Procalcitonin Accuracy for the Distinction Between Gram-Negative and Gram-Positive Bacterial Sepsis in Burn Patients

Is Procalcitonin a Valid Biomarker for Bacteremia in Patients Presenting to the Emergency Department?

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