title: Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients.
abstract: BACKGROUND
  Candidemia is a life-threatening infection in the ICU whose prognosis is highly dependent on the stage at which it is recognized. Procalcitonin (PCT) levels have been shown to accurately distinguish between bacteremia and noninfectious inflammatory states in critically ill patients with clinical signs of sepsis. Little is known about the accuracy of PCT for the diagnosis of candidemia in this setting.
  
  
  METHODS
  A medical intensive care unit in a teaching hospital.
  
  
  METHODS
  Review of the medical records of every non-neutropenic patient with either bacteremia or candidemia and clinical sepsis in whom PCT dosage at the onset of infection was available between May 2004 and December 2005.
  
  
  RESULTS
  Fifty episodes of either bacteremia (n=35) or candidemia (n=15) were included. PCT levels were found to be markedly higher in patients with bacteremia than in those with candidemia. Moreover, a low PCT value was found to be an independent predictor of candidemia in the study population. According to the calculation of the area under the receiver operating characteristic curve, PCT was found to be accurate in distinguishing between candidemia and bacteremia (0.96 [0.03]). A PCT level of higher than 5.5 ng/ml yields a 100% negative predictive value and a 65.2% positive predictive value for candidemia-related sepsis.
  
  
  CONCLUSIONS
  A high PCT value in a critically ill non-neutropenic patient with clinical sepsis is unlikely in the setting of candidemia.
authors.affiliation: Hôpital Le Bocage, Service de Réanimation Médicale, CHU de Dijon, France. pierre-emmanuel.charles@chu-dijon.fr
authors.forename: Pierre Emmanuel
authors.initials: PE
authors.lastname: Charles
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dalle
authors.forename: Serge
authors.initials: S
authors.lastname: Aho
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Quenot
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Doise
authors.forename: Hervé
authors.initials: H
authors.lastname: Aube
authors.forename: Nils-Olivier
authors.initials: NO
authors.lastname: Olsson
authors.forename: Bernard
authors.initials: B
authors.lastname: Blettery
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000175:diagnosis; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002177:Candidiasis / Q000097:blood*; D016009:Chi-Square Distribution; D016638:Critical Illness; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide