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Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients

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Abstract

Background

Candidemia is a life-threatening infection in the ICU whose prognosis is highly dependent on the stage at which it is recognized. Procalcitonin (PCT) levels have been shown to accurately distinguish between bacteremia and noninfectious inflammatory states in critically ill patients with clinical signs of sepsis. Little is known about the accuracy of PCT for the diagnosis of candidemia in this setting.

Setting

A medical intensive care unit in a teaching hospital.

Patients and methods

Review of the medical records of every non-neutropenic patient with either bacteremia or candidemia and clinical sepsis in whom PCT dosage at the onset of infection was available between May 2004 and December 2005.

Results

Fifty episodes of either bacteremia (n = 35) or candidemia (n = 15) were included. PCT levels were found to be markedly higher in patients with bacteremia than in those with candidemia. Moreover, a low PCT value was found to be an independent predictor of candidemia in the study population. According to the calculation of the area under the receiver operating characteristic curve, PCT was found to be accurate in distinguishing between candidemia and bacteremia (0.96 [0.03]). A PCT level of higher than 5.5 ng/ml yields a 100% negative predictive value and a 65.2% positive predictive value for candidemia-related sepsis.

Conclusion

A high PCT value in a critically ill non-neutropenic patient with clinical sepsis is unlikely in the setting of candidemia.

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Authors and Affiliations

  1. Service de Réanimation Médicale, Hôpital Le Bocage, C.H.U. de Dijon, France

    Pierre Emmanuel Charles, Jean-Pierre Quenot, Jean-Marc Doise, Hervé Aube & Bernard Blettery

  2. Laboratoire de Parasitologie-Mycologie, Hôpital Le Bocage, C.H.U. de Dijon, France

    Frédéric Dalle

  3. Service d’Epidémiologie et d’Hygiène Hospitalière, Hôpital Le Bocage, C.H.U. de Dijon, France

    Serge Aho

  4. Laboratoire d’Immunologie, Hôpital Le Bocage, C.H.U. de Dijon, France

    Nils-Olivier Olsson

Authors
  1. Pierre Emmanuel Charles
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  2. Frédéric Dalle
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  3. Serge Aho
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  4. Jean-Pierre Quenot
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  5. Jean-Marc Doise
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  7. Nils-Olivier Olsson
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  8. Bernard Blettery
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Correspondence to Pierre Emmanuel Charles.

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Charles, P.E., Dalle, F., Aho, S. et al. Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients. Intensive Care Med 32, 1577–1583 (2006). https://doi.org/10.1007/s00134-006-0306-3

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  • DOI: https://doi.org/10.1007/s00134-006-0306-3

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