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Usefulness of procalcitonin in differentiating Candida and bacterial blood stream infections in critically ill septic patients outside the intensive care unit

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Abstract

We aimed to explore the role of procalcitonin (PCT) for the diagnosis of Candida spp. bloodstream infections in a population of critically ill septic patients admitted to internal medicine units. This is a retrospective case–control study considering all cases of candidemia identified in three internal medicine units, from January 1st 2012 to May 31st 2016. For each case of candidemia, two patients with bacteremic sepsis were included in the study as control cases. The end point of the study was to evaluate the diagnostic performance of PCT for the diagnosis of Candida spp. blood stream infections in patients with objectively documented sepsis. Sixty-four patients with candidemia and 128 controls with bacteremia were enrolled. Median and interquartile range (IQR) PCT values are significantly lower in patients with candidemia (0.73; IQR 0.26–1.85 ng/mL) than in those with bacteremia (4.48; IQR 1.10–18.26 ng/mL). At ROC curve analysis, values of PCT greater than 2.5 ng/mL had a negative predictive value (NPV) of 98.3% with an AUC of 0.76 (0.68–0.84 95% CI) for the identification of Candida spp. from blood cultures. At multivariate analysis, a PCT value <2.5 ng/mL showed an odds ratio of 8.57 (95% CI 3.09–23.70; p < 0.0001) for candidemia. In septic patients at risk of Candida infection, a PCT value lower than 2.5 ng/mL should raise the suspicion of candidemia, adding value for considering prompt initiation of antifungal therapy.

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Authors and Affiliations

  1. Internal Medicine Unit 1, Careggi University Hospital, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy

    Filippo Pieralli, Lorenzo Corbo, Elisa Antonielli, Antonio Mancini & Carlo Nozzoli

  2. Internal Medicine Unit 2, Careggi University Hospital, Florence, Italy

    Arianna Torrigiani, Dario Mannini, Francesco Corradi & Alessandro Morettini

  3. Department of Medical Biotechnologies, University of Siena, Siena, Italy

    Fabio Arena & Gian Maria Rossolini

  4. Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy

    Alberto Moggi Pignone

  5. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Gian Maria Rossolini

  6. Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy

    Gian Maria Rossolini

  7. Don Carlo Gnocchi Foundation, Florence, Italy

    Gian Maria Rossolini

Authors
  1. Filippo Pieralli
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  2. Lorenzo Corbo
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  3. Arianna Torrigiani
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  4. Dario Mannini
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  5. Elisa Antonielli
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  6. Antonio Mancini
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  7. Francesco Corradi
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  8. Fabio Arena
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  9. Alberto Moggi Pignone
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  10. Alessandro Morettini
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  11. Carlo Nozzoli
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  12. Gian Maria Rossolini
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Correspondence to Filippo Pieralli.

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The authors declare that they have no conflict of interest.

Statement of human and animal rights

The study was performed in agreement with the principles set in the Declaration of Helsinki on human research ethics.

Informed consent

Informed consent was not needed in accordance to current regulatory laws on retrospective observational studies in our country. Local ethics committee approval was obtained (SepsiMed Study protocol number 0018329).

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Pieralli, F., Corbo, L., Torrigiani, A. et al. Usefulness of procalcitonin in differentiating Candida and bacterial blood stream infections in critically ill septic patients outside the intensive care unit. Intern Emerg Med 12, 629–635 (2017). https://doi.org/10.1007/s11739-017-1627-7

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  • DOI: https://doi.org/10.1007/s11739-017-1627-7

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