Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients.
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.
Charles
Pierre Emmanuel
PE
Hôpital Le Bocage, Service de Réanimation Médicale, CHU de Dijon, France. pierre-emmanuel.charles@chu-dijon.fr
Dalle
Frédéric
F
Aho
Serge
S
Quenot
Jean-Pierre
JP
Doise
Jean-Marc
JM
Aube
Hervé
H
Olsson
Nils-Olivier
NO
Blettery
Bernard
B
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
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide