Procalcitonin levels in surgical patients at risk of candidemia.
OBJECTIVE
Although the majority of cases of sepsis in intensive care unit (ICU) patients are due to bacterial infection, fungal infections are common and their early identification is important so that appropriate treatment can be started. Biomarkers have been used to aid diagnosis of bacterial infections, but their role in fungal infections is less defined. In this study we assessed the value of procalcitonin (PCT) levels for the diagnosis of candidemia or bacteremia in septic patients.


METHODS
We prospectively recorded PCT levels in 48 critically ill surgical patients with signs of sepsis and at high risk for fungal infection, and compared levels in patients with candidemia and bacteremia.


RESULTS
Bacterial species were isolated from blood cultures in 16 patients, Candida species in 17, and mixed bacterial and Candida species in 2 patients. PCT levels were less elevated in patients with candidemia (median 0.71 [IQR 0.5-1.1]) than in those with bacteremia (12.9 [2.6-81.2]). A PCT value less than 2 ng/ml enabled bacteremia to be ruled out with a negative predictive value of 94%, and had a similar positive predictive value for candidemia.


CONCLUSIONS
Our data indicate that a low PCT value in a critically ill septic patient is more likely to be related to candidemia than to bacteremia.
Department of Anesthesiology and Intensive Care, University of Verona, Verona, Italy.
Alvise
A
Martini
Leonardo
L
Gottin
Nicola
N
Menestrina
Vittorio
V
Schweiger
Davide
D
Simion
Jean-Louis
JL
Vincent
D000368:Aged; D016470:Bacteremia / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002175:Candida / Q000302:isolation & purification*; D002177:Candidiasis / Q000097:blood* / Q000382:microbiology; D003422:Critical Care; D005260:Female; D016469:Fungemia / Q000097:blood* / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012307:Risk Factors; D018709:Statistics, Nonparametric
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide