Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria.
BACKGROUND
In the ICU, bacteremia is a life-threatening infection whose prognosis is highly dependent on early recognition and treatment with appropriate antibiotics. Procalcitonin levels have been shown to distinguish between bacteremia and noninfectious inflammatory states accurately and quickly in critically ill patients. However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result.


METHODS
Review of the medical records of every patient treated between May, 2004 and December, 2006 who had bacteremia caused by either Gram positive (GP) or Gram negative (GN) bacteria, and whose PCT dosage at the onset of infection was available.


RESULTS
97 episodes of either GN bacteremia (n = 52) or GP bacteremia (n = 45) were included. Procalcitonin levels were found to be markedly higher in patients with GN bacteremia than in those with GP bacteremia, whereas the SOFA score value in the two groups was similar. Moreover, in the study population, a high PCT value was found to be independently associated with GN bacteremia. A PCT level of 16.0 ng/mL yielded an 83.0% positive predictive value and a 74.0% negative predictive value for GN-related bacteremia in the study cohort (AUROCC = 0.79; 95% CI, 0.71-0.88).


CONCLUSIONS
In a critically ill patient with clinical sepsis, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia, regardless of the severity of the disease.
Charles
Pierre Emmanuel
PE
Service de Réanimation Médicale, Hôpital Le Bocage, C.H.U. de DIJON, France. pierre-emmanuel.charles@chu-dijon.fr
Ladoire
Sylvain
S
Aho
Serge
S
Quenot
Jean-Pierre
JP
Doise
Jean-Marc
JM
Prin
Sébastien
S
Olsson
Niels-Olivier
NO
Blettery
Bernard
B
D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000097:blood* / Q000382:microbiology / Q000401:mortality; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000097:blood* / Q000382:microbiology / Q000401:mortality; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000097:blood* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D016896:Treatment Outcome
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide