Abstract
BackgroundProcalcitonin (PCT) is a biomarker used to assess systemic inflammation, infection, and sepsis and to optimize antimicrobial therapies. Its role in the in the differential diagnosis between candidemia and bacteremia is unclear. The aim of this systematic review was to summarize the current evidence about PCT values for differentiating candidemia from bacteremia.MethodsPubMed and EMBASE were searched for studies reporting data on the diagnostic performance of serum PCT levels in intensive care unit (ICU) or non-ICU adult patients with candidemia, in comparison to patients with bacteremia.ResultsWe included 16 studies for a total of 45.079 patients and 785 cases of candidemia. Most studies claimed to report data relating to the use of PCT values for differentiating between candidemia and bacteremia in septic patients in the intensive care unit. However, the studies identified were all retrospective, except for one secondary analysis of a prospective dataset, and clinically very heterogeneous and involved different assessment methods. Most studies did show lower PCT values in patients with candidemia compared to bacteremia. However, the evidence supporting this observation is of low quality and the difference seems insufficiently discriminative to guide therapeutic decisions. None of the studies retrieved actually studied guidance of antifungal treatment by PCT. PCT may improve diagnostic performance regarding candidemia when combined with other biomarkers of infection (e.g., beta-d-glucan) but more data is needed.ConclusionsPCT should not be used as a standalone tool for the differential diagnosis between candidemia and bacteremia due to limited supporting evidence.
Highlights
Procalcitonin (PCT) is a biomarker used to assess systemic inflammation, infection, and sepsis and to optimize antimicrobial therapies
In this systematic review of the value of PCT for differentiating between candidemia and bacteremia, we found that PCT has been studied in only 785 cases of candidemia
Most of the studies identified evaluated the use of PCT for differentiating between candidemia and bacteremia in septic patients in the intensive care unit (ICU)
Summary
Procalcitonin (PCT) is a biomarker used to assess systemic inflammation, infection, and sepsis and to optimize antimicrobial therapies. The absence of sensitive and specific clinical signs and symptoms and radiological findings as well as the prolonged time of blood culture growth hamper early identification of candidemia [2, 4] Adding to this is the need to differentiate between bacterial and fungal infections, which often have similar clinical manifestations. For these reasons, risk factor clinical characteristics, scoring systems, and microbiological techniques (culture- and nonculture-based) are all being used to optimize early treatment and reduce unnecessary antifungal therapy [4,5,6,7,8,9,10,11,12,13]. The mechanism for this finding is unclear, patients with invasive candidiasis showed signs of impaired inflammatory response, immune cell exhaustion, and reduced
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