Procalcitonin serum levels in perinatal bacterial and fungal infection of preterm infants

Abstract

Aim: To determine reference values for procalcitonin (PCT) and C‐reactive protein (CRP) for gestational age and to use these parameters as diagnostic markers of perinatal bacterial and fungal infection. Methods: PCT and CRP serum levels were measured in a case‐control study in a group of 35 low birthweight infants (>34wk of gestation). 27 babies (77%) had clinical signs of infection confirmed by positive blood cultures and were compared to 8 (23%) uninfected matched patients. Seventeen (63%) of them had bacterial infection and 10 (37%) had fungal infection (Candida). Serum PCT (Brahms Diagnostika) and CRP (Immunoassay Vitros 950) were measured serially at 3, 7 and 10 d of life. Results: At any time, PCT and CRP levels were significantly higher in neonates with perinatal infection (p < 0.05) (>0.7 ng ml−1 and >1 mg dl−1, respectively). PCT showed a more rapid response to infection (9.3 ± 1.5 ng ml−1), especially to bacterial infection (10.8 ± 1.4 ng ml−1), than CRP (1.5 ± 0.5 mg dl−1) (sensitivity 99% vs 88%). Lower sensitivity was noted for both parameters, PCT and CRP, to follow babies with fungal infection (6.7 ± 0.8 ng ml−1 and 0.9 ± 0.7 mg dl−1, respectively) (sensitivity 77% vs 58%). Conclusion: This study gives PCT reference values in preterm babies with perinatal infection. In these babies, PCT seems to be more sensitive than CRP as a diagnostic marker of infection. Both parameters can be used alone or in combination for a better identification and follow‐up of bacterial and fungal infection during the perinatal period.

Procalcitonin levels in surgical patients at risk of candidemia

“…A limitation is that it was conducted in a single center, and had a relatively small sample size, although similar studies have also included relatively small numbers of patients. 18,19,21,22 In conclusion, our data indicate that a low PCT value (less than 2.0 ng/mL) in a surgical patient with clinical signs of sepsis and risk factors for fungal infections is more likely to be related to candidemia than to bacteremia. Figure 3 Linear regression line between log (PCT) and degree of organ dysfunction (SOFA-score).…”

“…10e15,17 Several other studies have reported lower PCT levels in patients with fungal than in those with bacterial infections. 18,19,21 Distefano et al compared PCT and CRP levels in low birthweight infants 21 ; PCT levels were significantly lower in babies with fungal than in those with bacterial infections. Petrikkos and co-workers first evaluated serum PCT levels in fungal infections 18 and then the power of PCT and mannan antigen to distinguish fungal from bacterial infection.…”

Procalcitonin assay in systemic inflammation, infection, and sepsis: Clinical utility and limitations

“…In septic infants and children, ProCT was noted to increase earlier than CRP and had a greater sensitivity and negative predictive value (140). Similarly, other studies found ProCT to be an earlier marker of infection or sepsis (104,124). In bacterial endocarditis, in addition to ProCT being more accurate diagnostically than CRP, ProCT levels fell more rapidly with recovery (114).…”

“…Serum ProCT levels were reportedly higher in severe fungal infections (123). A study of infants with clinical signs of infection revealed that among ten patients with candidiasis, the mean ProCT was 6.7 ng/mL as compared with a somewhat higher mean of 10.8 ng/mL for patients with bacterial infection (124). As is the case with viral infections, it is not known to what extent the high levels occurring in some patients with systemic fungal infection may be due to translocation of microbial constituents from the gut or to secondary bacterial infection (125).…”

“…Among sick infants and children, the evaluation of ProCT studies has also been a topic of interest (28, 124,133). In a study of 80 children (ranging in age from 1 month to 16 yrs) who were admitted to a pediatric intensive care unit for the suspicion of sepsis (133), there was a wide range of the admission serum ProCT levels (ranging from 1 to 722 ng/mL).…”