title: Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria.
abstract: 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.
authors: Service de Réanimation Médicale, Hôpital Le Bocage, C.H.U. de DIJON, France. pierre-emmanuel.charles@chu-dijon.fr
authors: Pierre Emmanuel
authors: PE
authors: Charles
authors: Sylvain
authors: S
authors: Ladoire
authors: Serge
authors: S
authors: Aho
authors: Jean-Pierre
authors: JP
authors: Quenot
authors: Jean-Marc
authors: JM
authors: Doise
authors: Sébastien
authors: S
authors: Prin
authors: Niels-Olivier
authors: NO
authors: Olsson
authors: Bernard
authors: B
authors: Blettery
mesh_terms: 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
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide