Top

BMC Neurology

Published in:

Open Access 01-12-2020 | Stroke | Research article

Early diagnostic value of serum procalcitonin levels for catheter-related blood stream infection in first-ever acute ischemic stroke patients

Authors: Yicheng Xu, Ruiwei Chen, Wei Qin, Peifu Wang, Peiyao Li, Wenli Hu, Jichen Du

Published in: BMC Neurology | Issue 1/2020

Abstract

Objective

The traditional approaches for diagnosing catheter-related bloodstream infection(CRBSI) is time consuming, which could not meet the clinical requirement. Our aim was to investigate the value of serum procalcitonin(PCT) in predicting CRBSI in first-ever acute ischemic stroke patients with central venous catheters (CVCs).

Methods

This was a retrospective study. First-ever acute ischemic stroke patients hospitalized in neurological intensive care unit(NICU) of Aerospace Center Hospital and NICU of Beijing Chaoyang Hospital during January 2010 and December 2017 with clinically suspected CRBSI were enrolled. Peripheral blood white blood cell (WBC) count, neutrophils percentage(NE%), the levels of serum PCT, dwell time of catheterization and outcome of the patients were collected. According to the diagnosis of CRBSI or not, they were divided into CRBSI group and no CRBSI group. We used receiver operating characteristic curve (ROC) to evaluate the value of serum PCT levels in predicting CRBSI in patients with clinically suspected CRBSI.

Results

Forty-five patients with suspected CRBSI were included in this study, and 13 patients were diagnosed with CRBSI. Comparing to those in no CRBSI group, the maximum body temperature (T_max) (p = 0.036) and the PCT levels (P = 0.013) in CRBSI group were both significantly higher. The area under ROC of the serum PCT levels and the T_max to predict the CRBSI were 0.803 (0.95CI,0.660–0.946) and 0.680 (0.95CI,0.529–0.832) respectively. The PCT cut-off value was 0.780 ng/ml, with the sensitivity 69.23%, specificity 87.50%, positive predictive values 69.23% and negative predictive values 87.50%.

Conclusion

It could be helpful to adopt PCT as a rapid diagnostic biomarker for first-ever acute stroke patients with suspected CRBSI.

Lambert ML, Suetens C, Savey A, et al. Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study. Lancet Infect Dis. 2011;11(1):30–8.PubMedCrossRef

Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. Jama. 2009;302(21):2323–9.PubMedCrossRef

Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1–45.PubMedPubMedCentralCrossRef

Theodorou VP, Papaioannou VE, Tripsianis GA, et al. Procalcitonin and procalcitonin kinetics for diagnosis and prognosis of intravascular catheter-related bloodstream infections in selected critically ill patients: a prospective observational study. BMC Infect Dis. 2012;12:247.PubMedPubMedCentralCrossRef

O'Grady NP, Barie PS, Bartlett JG, et al. Practice guidelines for evaluating new fever in critically ill adult patients. Task force of the Society of Critical Care Medicine and the Infectious Diseases Society of America. Clin Infect Dis. 1998;26(5):1042–59.PubMedCrossRef

Rijnders BJ, Peetermans WE, Verwaest C, Wilmer A, Van Wijngaerden E. Watchful waiting versus immediate catheter removal in ICU patients with suspected catheter-related infection: a randomized trial. Intensive Care Med. 2004;30(6):1073–80.PubMedCrossRef

Cook D, Randolph A, Kernerman P, et al. Central venous catheter replacement strategies: a systematic review of the literature. Crit Care Med. 1997;25(8):1417–24.PubMedCrossRef

Muller B, White JC, Nylen ES, Snider RH, Becker KL, Habener JF. Ubiquitous expression of the calcitonin-i gene in multiple tissues in response to sepsis. J Clin Endocrinol Metab. 2001;86(1):396–404.PubMed

Schuetz P, Raad I, Amin DN. Using procalcitonin-guided algorithms to improve antimicrobial therapy in ICU patients with respiratory infections and sepsis. Curr Opin Crit Care. 2013;19(5):453–60.PubMedCrossRef

10.

Hu L, Shi Q, Shi M, Liu R, Wang C. Diagnostic value of PCT and CRP for detecting serious bacterial infections in patients with fever of unknown origin: a systematic review and meta-analysis. Appl Immunohistochem Mol Morphol. 2017;25(8):e61–e9.PubMedCrossRef

11.

Chirouze C, Schuhmacher H, Rabaud C, et al. Low serum procalcitonin level accurately predicts the absence of bacteremia in adult patients with acute fever. Clin Infect Dis. 2002;35(2):156–61.PubMedCrossRef

12.

The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration. WHO MONICA Project Principal Investigators. J Clin Epidemiol. 1988;41(2):105–14.CrossRef

13.

Ozsurekci Y, Oktay Arikan K, Bayhan C, et al. Can procalcitonin be a diagnostic marker for catheter-related blood stream infection in children? J Pediatr. 2016;92(4):414–20.CrossRef

14.

2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2013;31(10):1925–38.CrossRef

15.

Olaechea PM, Palomar M, Alvarez-Lerma F, et al. Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients. Revista espanola de quimioterapia. 2013;26(1):21–9.PubMed

16.

Merrer J, De Jonghe B, Golliot F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. Jama. 2001;286(6):700–7.PubMedCrossRef

17.

Raad I, Hanna H, Maki D. Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis. 2007;7(10):645–57.PubMedCrossRef

18.

Moretti D, Ramirez MM, Settecase CJ, Bagilet DH, Quaglino MB. Usefulness of procalcitonin upon admission to intensive care in the diagnosis and prognosis of sepsis. Med Int. 2013;37(3):156–62.

19.

Mongardon N, Lemiale V, Perbet S, et al. Value of procalcitonin for diagnosis of early onset pneumonia in hypothermia-treated cardiac arrest patients. Intensive Care Med. 2010;36(1):92–9.PubMedCrossRef

20.

Charles PE, Dalle F, Aho S, et al. Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients. Intensive Care Med. 2006;32(10):1577–83.PubMedCrossRef

21.

Chen J, Wang Y, Shen Z, Zhu Z, Song Y, Han R. Early diagnostic value of plasma PCT and BG assay for CRBSI after OLT. Transplant Proc. 2011;43(5):1777–9.PubMedCrossRef

Title: Early diagnostic value of serum procalcitonin levels for catheter-related blood stream infection in first-ever acute ischemic stroke patients
Authors: Yicheng Xu
Ruiwei Chen
Wei Qin
Peifu Wang
Peiyao Li
Wenli Hu
Jichen Du
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Stroke
Central Venous Catheter
Published in: BMC Neurology / Issue 1/2020
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-019-1557-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Early diagnostic value of serum procalcitonin levels for catheter-related blood stream infection in first-ever acute ischemic stroke patients

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

A case report of an intermediate phenotype between congenital myasthenic syndrome and D-2- and L-2-hydroxyglutaric aciduria due to novel SLC25A1 variants

Sensor-based systems for early detection of dementia (SENDA): a study protocol for a prospective cohort sequential study

Self-perceived postural balance correlates with postural balance and anxiety during the first year after stroke: a part of the randomized controlled GOTVED study

Childhood neurodegeneration associated with a specific UBTF variant: a new case report and review of the literature

Routinely collected patient data in neurology research: a systematic mapping review

A novel POLR3A genotype leads to leukodystrophy type-7 in two siblings with unusually late age of onset