Skip to main content
SpringerLink
Log in

Correlation of procalcitonin to positive blood culture results in a sample of South African trauma ICU patients between 2016 and 2017

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

This study sought to investigate the screening accuracy of procalcitonin (PCT) for bacteremia, as defined by a positive blood culture, in a South African trauma ICU.

Methods

This was a retrospective chart review study involving 149 patients who were admitted to the ICU of a level-1 trauma center in South Africa between 2016 and 2017. Median PCT levels in patients with and without positive blood cultures were compared. The screening accuracy of PCT for a positive blood culture was summarized as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Two PCT cut-points were investigated: a general cut-point in the South African context (> 2.0 ng/mL), and a trauma ICU-specific cut-point (prioritizing specificity while optimizing sensitivity) which was determined from a receiver-operator-characteristic curve.

Results

Bacteremic patients had higher median PCT levels when compared with non-bacteremic patients (30.5 ng/mL versus 6.6 ng/mL, p = 0.002). The sensitivity, specificity, PPV, and NPV of PCT > 2.0 ng/mL was 86% (95% confidence interval-CI 71–94%), 29% (CI 22–38%), 28% (CI 20–37%), and 87% (CI 73–94%), respectively. The unit-specific cut-point was PCT > 31.0 ng/mL, which had a sensitivity, specificity, PPV, and NPV of 50% (CI 34–66%), 80% (CI 71–86%), 44% (CI 30–59%), and 83% (CI 75–89%), respectively. Unlike PCT > 2.0 ng/mL, PCT > 31.0 ng/mL demonstrated fair-to-good test specificity in a sub-analysis of patients who underwent recent surgery.

Conclusions

Increased PCT levels were associated with bacteremia in this study. PCT > 31.0 ng/mL may be used to rule in suspected bacteremia in this trauma ICU setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Christaki E, Giamarellos-Bourboulis EJ. The complex pathogenesis of bacteremia: from antimicrobial clearance mechanisms to the genetic background of the host. Virulence. 2014;5(1):57–655.

    Article  Google Scholar 

  2. Valles J, Leon C, Alvarez-Lerma F. Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Spanish Collaborative Group for Infections in Intensive Care Units of Sociedad Espanola de Medicina Intensiva y Unidades Coronarias (SEMIUC). Clin Infect Dis. 1997;24(3):387–95.

    Article  CAS  Google Scholar 

  3. Laupland KB, Zygun DA, Davies HD, Church DL, Louie TJ, Doig CJ. Population-based assessment of intensive care unit-acquired bloodstream infections in adults: incidence, risk factors, and associated mortality rate. Crit Care Med. 2002;30(11):2462–7.

    Article  Google Scholar 

  4. Garrouste-Orgeas M, Timsit JF, Tafflet M, et al. Excess risk of death from intensive care unit-acquired nosocomial bloodstream infections: a reappraisal. Clin Infect Dis. 2006;42(8):1118–26.

    Article  Google Scholar 

  5. Valles J, Ferrer R. Bloodstream infection in the ICU. Infect Dis Clin North Am. 2009;23(3):557–69.

    Article  Google Scholar 

  6. Gounder M, Hardcastle T, Muckart D. A review of the complications encountered in a quaternary trauma intensive care unit in South Africa. S Afr J Surg. 2019;57(1):43–8.

    Article  Google Scholar 

  7. Calandra T, Cometta A. Antibiotic therapy for gram-negative bacteremia. Infect Dis Clin North Am. 1991;5(4):817–34.

    Article  CAS  Google Scholar 

  8. Jin M, Khan AI. Procalcitonin: uses in the clinical laboratory for the diagnosis of sepsis. Lab Med. 2010;41(3):173–7.

    Article  Google Scholar 

  9. Claxton AN, Dark PM. Biomarker-guided antibiotic cessation in sepsis: evidence and future challenges. Br J Hosp Med (Lond). 2018;79(3):136–41.

    Article  Google Scholar 

  10. Hoeboer SH, van der Geest PJ, Nieboer D, Groeneveld AB. The diagnostic accuracy of procalcitonin for bacteraemia: a systematic review and meta-analysis. Clin Microbiol Infect. 2015;21(5):474–81.

    Article  CAS  Google Scholar 

  11. Meisner M, Tschaikowsky K, Hutzler A, Schick C, Schuttler J. Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Med. 1998;24(7):680–4.

    Article  CAS  Google Scholar 

  12. Cheddie S, Muckart DJ, Hardcastle TC, Den Hollander D, Cassimjee H, Moodley S. Direct admission versus inter-hospital transfer to a level I trauma unit improves survival: an audit of the new Inkosi Albert Luthuli Central Hospital trauma unit. S Afr Med J. 2011;101(3):176–8.

    Article  CAS  Google Scholar 

  13. Vetter TR, Schober P, Mascha EJ. Diagnostic testing and decision-making: beauty is not just in the eye of the beholder. Anesth Analg. 2018;127(4):1085–91.

    Article  Google Scholar 

  14. Maceneaney PM, Malone DE. The meaning of diagnostic test results: a spreadsheet for swift data analysis. Clin Radiol. 2000;55(3):227–35.

    Article  CAS  Google Scholar 

  15. Eisenberg MJ. Accuracy and predictive values in clinical decision-making. Cleve Clin J Med. 1995;62(5):311–6.

    Article  CAS  Google Scholar 

  16. Parikh R, Mathai A, Parikh S, Chandra Sekhar G, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol. 2008;56(1):45–50.

    Article  Google Scholar 

  17. Bujang MA, Adnan TH. Requirements for minimum sample size for sensitivity and specificity analysis. J Clin Diagn Res. 2016;10(10):Ye01–Ye06.

    PubMed  PubMed Central  Google Scholar 

  18. Caffarini EM, DeMott J, Patel G, Lat I. Determining the clinical utility of an absolute procalcitonin value for predicting a positive culture result. Antimicrob Agents Chemother. 2017;61(5):e02007–e020016.

    Article  CAS  Google Scholar 

  19. Yu Y, Li XX, Jiang LX, et al. Procalcitonin levels in patients with positive blood culture, positive body fluid culture, sepsis, and severe sepsis: a cross-sectional study. Infect Dis (Lond). 2016;48(1):63–9.

    Article  CAS  Google Scholar 

  20. Yunus I, Fasih A, Wang Y. The use of procalcitonin in the determination of severity of sepsis, patient outcomes and infection characteristics. PLoS ONE. 2018;13(11):e0206527.

    Article  Google Scholar 

  21. Bassetti M, Russo A, Righi E, et al. Role of procalcitonin in bacteremic patients and its potential use in predicting infection etiology. Expert Rev Anti Infect Ther. 2019;17(2):99–105.

    Article  CAS  Google Scholar 

  22. Vincent JL, Bassetti M, Francois B, et al. Advances in antibiotic therapy in the critically ill. Crit Care. 2016;20(1):133.

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Gulshan Yashveer Beejan for the assistance with the first draft grammar edit and Ms. Tonya Esterhuizen and Prof. Yoshan Moodley for their statistical expertise.

Author information

Authors and Affiliations

  1. University of KwaZulu-Natal, Durban, South Africa

    Dirouvarlen Ramasawmy

  2. Durban, South Africa

    Maheshan Pillay

  3. Trauma and Burns, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, Durban, 4058, South Africa

    Timothy Craig Hardcastle

  4. Department of Surgery, University of KwaZulu-Natal, Congella, Durban, South Africa

    Timothy Craig Hardcastle

Authors
  1. Dirouvarlen Ramasawmy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maheshan Pillay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Timothy Craig Hardcastle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy Craig Hardcastle.

Ethics declarations

Conflict of interest

No authors declare any conflict of interest. This work is toward the degree MMed(Surgery) for the first author and the third author was the supervisor.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramasawmy, D., Pillay, M. & Hardcastle, T.C. Correlation of procalcitonin to positive blood culture results in a sample of South African trauma ICU patients between 2016 and 2017. Eur J Trauma Emerg Surg 47, 1183–1188 (2021). https://doi.org/10.1007/s00068-019-01295-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-019-01295-y

Keywords

Search

Navigation