Abstract
ObjectiveThe traditional approaches for diagnosing catheter-related bloodstream infection(CRBSI) is time consuming, which could not meet the clinical requirement. Our aim was to investigate the value of serum procalcitonin(PCT) in predicting CRBSI in first-ever acute ischemic stroke patients with central venous catheters (CVCs).MethodsThis was a retrospective study. First-ever acute ischemic stroke patients hospitalized in neurological intensive care unit(NICU) of Aerospace Center Hospital and NICU of Beijing Chaoyang Hospital during January 2010 and December 2017 with clinically suspected CRBSI were enrolled. Peripheral blood white blood cell (WBC) count, neutrophils percentage(NE%), the levels of serum PCT, dwell time of catheterization and outcome of the patients were collected. According to the diagnosis of CRBSI or not, they were divided into CRBSI group and no CRBSI group. We used receiver operating characteristic curve (ROC) to evaluate the value of serum PCT levels in predicting CRBSI in patients with clinically suspected CRBSI.ResultsForty-five patients with suspected CRBSI were included in this study, and 13 patients were diagnosed with CRBSI. Comparing to those in no CRBSI group, the maximum body temperature (Tmax) (p = 0.036) and the PCT levels (P = 0.013) in CRBSI group were both significantly higher. The area under ROC of the serum PCT levels and the Tmax to predict the CRBSI were 0.803 (0.95CI,0.660–0.946) and 0.680 (0.95CI,0.529–0.832) respectively. The PCT cut-off value was 0.780 ng/ml, with the sensitivity 69.23%, specificity 87.50%, positive predictive values 69.23% and negative predictive values 87.50%.ConclusionIt could be helpful to adopt PCT as a rapid diagnostic biomarker for first-ever acute stroke patients with suspected CRBSI.
Highlights
Central venous catheters (CVCs) have become an important part in caring for severe patients, including those in neurological intensive care unit(NICU)
Patients who have reached 18 years of age or older got first-ever acute ischemic stroke which defined in accordance with the World Health Organization criteria [12], and accepted central venous catheters (CVCs) for treatment during NICU were eligible for inclusion
In our study, we investigated the early diagnostic ability of serum PCT levels for catheter-related bloodstream infection (CRBSI) in patients with first-ever acute ischemic stroke hospitalized in NICU
Summary
Central venous catheters (CVCs) have become an important part in caring for severe patients, including those in neurological intensive care unit(NICU). The traditional approaches require the confirmation of CRBSI which was based on the culture of catheter tips and peripheral blood. One important reason for physicians to suspect CRBSI and to remove the central venous catheter was the presence of fever. Studies had found that up to 70% or more catheters removed for suspected CRBSI were proved to be unnecessary, which resulted in increased risk of iatrogenic complications, unnecessary antibiotics use and increased health care expenditures [6, 7]
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