Abstract
BackgroundIn 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.MethodsReview 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.Results97 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).ConclusionIn 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.
Highlights
In the ICU, bacteremia is a life-threatening infection whose prognosis is highly dependent on early recognition and treatment with appropriate antibiotics
Two distinct episodes of bloodstream infection (BSI) were recorded for a patient if at least 6 days had elapsed between the 2 positive blood cultures, provided appropriate therapy had been implemented and significant clinical improvement had been obtained between the two episodes
Our model showed that PCT elevation was independently associated with the risk of Gram negative (GN) bacteremia regardless of the infection source and the severity of the disease (Odds ratio = 4.17, 95% confidence interval, 2.08–8.33, p < 0.001) (Table 3)
Summary
In the ICU, bacteremia is a life-threatening infection whose prognosis is highly dependent on early recognition and treatment with appropriate antibiotics. In everyday clinical practice, 12 to 24 hours are usually required to obtain the Gram stain result, once bacteria have been recovered from blood cultures. The outcome may be worse and the length of stay longer [8]. Other new approaches such as universal polymerase chain reaction (PCR) make it possible to identify bacteria quickly and reliably, but these are not routinely available in most centers [9]. Knowledge of the clinical manifestations is invaluable, surrogate markers could help to identify the main human bacterial pathogens within the first hours of management of patients with bacteremia
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