Volume 19 Supplement 1

35th International Symposium on Intensive Care and Emergency Medicine

Open Access

Differential diagnosis of bacterial from candidal bloodstream infections in ICU patients: the role of procalcitonin

  • E Angelopoulos1,
  • E Perivolioti1,
  • S Kokkoris1,
  • E Douka1,
  • E Barbouti1,
  • P Temperekidis1,
  • C Vrettou1,
  • C Psachoulia1,
  • G Poulakou2,
  • S Zakynthinos1 and
  • C Routsi1
Critical Care201519(Suppl 1):P68

https://doi.org/10.1186/cc14148

Published: 16 March 2015

Introduction

Early differentiation of bacterial from candidal bloodstream infections (BSIs) in the presence of sepsis or septic shock is crucial because of the need for appropriate treatment initiation. Clinical data, although limited, suggest a role for procalcitonin (PCT) [13]. The aim of this study was to investigate a possible association between the etiology of BSIs and the serum PCT levels.

Methods

ICU patients with clinical and laboratory signs of sepsis or septic shock, with documented BSIs and with both serum PCT and CRP measurements on the day of the positive blood sample (±1 day), were included. Illness severity was assessed by SOFA score on both admission and BSI day. Demographic, clinical, and laboratory data including PCT and CRP levels, as well as the white blood cell (WBC) count on the day of the BSI were recorded. PCT was measured by an electrochemiluminescence analyzer and CRP by the tholosimetric method (Roche, Switzerland).

Results

A total of 64 ICU patients (mean age 58 ± 18 years, 39 males) with BSIs were included. SOFA sore was 9 ± 4 on ICU admission and 8 ± 4 on the day of BSI. In 30 of these patients Candida spp. were isolated in blood culture (candidemia group) whereas the remaining 34 had a bacterial etiology of BSI (bacteremia group). Serum PCT concentrations remained within normal ranges in most patients with candidemia whereas a wide range was observed in patients with bacteremia. Mean values of PCT and CRP levels were higher in the bacterial than in the candidemia BSI group: 18.5 ± 33.2 versus 0.73 ± 1.40 ng/ml, P < 0.001 and 17.7 ± 10.3 versus 8.9 ± 8.0 mg/dl, P = 0.001, respectively. There was a significant difference in WBC count between the two groups: 19,460 ± 10.174 versus 11,000 ± 5,440, P < 0.001 for the bacteremia and candidemia BSI group, respectively. A ROC curve analysis of the predictive ability of PCT showed an AUC of 0.79 (P < 0.001). When a cutoff point of 0.40 ng/ml was selected using Youden's J statistic, a low value of PCT had in our sample a negative predictive value of 0.76 and a likelihood ratio (negative) of 0.30.\

Conclusion

A low serum PCT value could be considered as a diagnostic marker in distinguishing between BSIs of candidal or bacterial origin in ICU patients with varying severity of sepsis.

Authors’ Affiliations

(1)
Evangelismos Hospital
(2)
Attikon Hospital

References

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Copyright

© Angelopoulos et al.; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.

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