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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2014

Open Access 01-12-2014 | Research article

Procalcitonin as a marker of Candida species detection by blood culture and polymerase chain reaction in septic patients

Authors: Andrea Cortegiani, Vincenzo Russotto, Francesca Montalto, Grazia Foresta, Giuseppe Accurso, Cesira Palmeri, Santi Maurizio Raineri, Antonino Giarratano

Published in: BMC Anesthesiology | Issue 1/2014

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Abstract

Background

The aim of our study is to test procalcitonin (PCT) as surrogate marker of identification of Candida spp. by blood culture (BC) and real-time-polymerase chain reaction (PCR), whether alone or in association with bacteria, in septic patients.

Methods

We performed a single-centre retrospective study. We reviewed the clinical charts of patients with a diagnosis of severe sepsis or septic shock treated at our general intensive care unit from March 2009 to March 2013. We analysed all diagnostic episodes consisting of BC, real-time PCR assay and dosage of PCT. We registered age, sex, white blood count, sequential organ failure assessment score and type of admission between medical or surgical. When inclusion criteria were met more than once, we registered the new diagnostic episode as subsequent diagnostic episode. The diagnostic performance of PCT to predict Candida spp. identification alone or in mixed infections by either BC or PCR was tested using the receiver-operative characteristic curve. Logistic regression was constructed using presence of Candida spp. as the dependent variable.

Results

A total of 260 diagnostic episodes met the inclusion criteria. According to BC results classification, a significantly lower value of PCT was observed in Candida spp. BSI (0.99 ng/ml, 0.86 - 1.34) than in BSI caused by bacteria (16.7 ng/ml, 7.65 - 50.2) or in mixed infections (4.76 ng/ml, 2.98 - 6.08). Similar findings were observed considering PCR results. A cut-off of ≤ 6.08 ng/ml for PCT yielded a sensitivity of 86.8%, a specificity of 87.4%, a positive predictive value of 63.9%, a negative predictive value (NPV) of 96.3% and an area under the curve of 0.93 for Candida spp. identification by BC. A similar high NPV for a cut-off ≤ 6.78 ng/ml was observed considering the classification of diagnostic episodes according to PCR results, with an AUC of 0.85. A subsequent diagnostic episode was independently associated with Candida spp. detection either by BC or PCR.

Conclusion

PCT could represent a useful diagnostic tool to exclude the detection of Candida spp. by BC and PCR in septic patients.
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Literature
1.
Vincent J-L, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y: International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009, 302 (21): 2323-2329. 10.1001/jama.2009.1754.CrossRefPubMed
2.
Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB: Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004, 39 (3): 309-317. 10.1086/421946.CrossRefPubMed
3.
Kett DH, Azoulay E, Echeverria PM, Vincent J-L: Candida bloodstream infections in intensive care units: Analysis of the extended prevalence of infection in intensive care unit study*. Crit Care Med. 2011, 39 (4): 665-670. 10.1097/CCM.0b013e318206c1ca.CrossRefPubMed
4.
Morrell M, Fraser VJ, Kollef MH: Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: a potential risk factor for hospital mortality. Antimicrob Agents Chemother. 2005, 49 (9): 3640-3645. 10.1128/AAC.49.9.3640-3645.2005.CrossRefPubMedPubMedCentral
5.
Patel GP, Simon D, Scheetz M, Crank CW, Lodise T, Patel N: The effect of time to antifungal therapy on mortality in candidemia associated septic shock. Am J Ther. 2009, 16 (6): 508-511. 10.1097/MJT.0b013e3181a1afb7.CrossRefPubMed
6.
Morgan J, Meltzer MI, Plikaytis BD, Sofair AN, Huie-White S, Wilcox S, Harrison LH, Seaberg EC, Hajjeh RA, Teutsch SM: Excess mortality, hospital stay, and cost due to candidemia: a case–control study using data from population-based candidemia surveillance. Infect Control Hosp Epidemiol. 2005, 26 (6): 540-547. 10.1086/502581.CrossRefPubMed
7.
Cuenca‒Estrella M, Verweij PE, Arendrup MC, Arikan‒Akdagli S, Bille J, Donnelly JP, Jensen HE, Lass‒Flörl C, Richardson MD, Akova M: ESCMID* guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures. Clin Microbiol Infect. 2012, 18 (s7): 9-18.CrossRef
8.
Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE, Filler SG, Fisher JF, Kullberg B-J, Zeichner LO, Reboli AC, Rex JH, Walsh TJ, Sobe JD: Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009, 48 (5): 503-535. 10.1086/596757.CrossRefPubMed
9.
Cornely OA, Bassetti M, Calandra T, Garbino J, Kullberg B-J, Lortholary O, Meersseman W, Akova M, Arendrup M, Arikan Akdagli S: ESCMID* guideline for the diagnosis and management of Candida diseases 2012: nonneutropenic adult patients. Clin Microbiol Infect. 2012, 18 (s7): 19-37.CrossRefPubMed
10.
Held J, Kohlberger I, Rappold E, Grawitz AB, Häcker G: Comparison of (1 → 3)-β-d-Glucan, Mannan/Anti-Mannan Antibodies, and Cand-Tec Candida Antigen as Serum Biomarkers for Candidemia. J Clin Microbiol. 2013, 51 (4): 1158-1164. 10.1128/JCM.02473-12.CrossRefPubMedPubMedCentral
11.
Albert O, Toubas D, Strady C, Cousson J, Delmas C, Vernet V, Villena I: Reactivity of (1 → 3)-β-d-glucan assay in bacterial bloodstream infections. Eur J Clin Microbiol Infect Dis. 2011, 30 (11): 1453-1460. 10.1007/s10096-011-1244-8.CrossRefPubMed
12.
Kanamori H, Kanemitsu K, Miyasaka T, Ameku K, Endo S, Aoyagi T, Inden K, Hatta M, Yamamoto N, Kunishima H: Measurement of (1–3)-β-d-glucan derived from different gauze types. Tohoku J Exp Med. 2009, 217 (2): 117-121. 10.1620/tjem.217.117.CrossRefPubMed
13.
Koo S, Bryar JM, Page JH, Baden LR, Marty FM: Diagnostic performance of the (1 → 3)-β-d-glucan assay for invasive fungal disease. Clin Infect Dis. 2009, 49 (11): 1650-1659. 10.1086/647942.CrossRefPubMed
14.
Digby J, Kalbfleisch J, Glenn A, Larsen A, Browder W, Williams D: Serum glucan levels are not specific for presence of fungal infections in intensive care unit patients. Clin Diagn Lab Immunol. 2003, 10 (5): 882-885.PubMedPubMedCentral
15.
Mikulska M, Calandra T, Sanguinetti M, Poulain D, Viscoli C: The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: recommendations from the Third European Conference on Infections in Leukemia. Crit Care. 2010, 14 (6): R222-10.1186/cc9365.CrossRefPubMedPubMedCentral
16.
Kourkoumpetis TK, Fuchs BB, Coleman JJ, Desalermos A, Mylonakis E: Polymerase Chain Reaction–Based Assays for the Diagnosis of Invasive Fungal Infections. Clin Infect Dis. 2012, 54 (9): 1322-1331. 10.1093/cid/cis132.CrossRefPubMedPubMedCentral
17.
Avni T, Leibovici L, Paul M: PCR diagnosis of invasive candidiasis: systematic review and meta-analysis. Eur J Clin Microbiol. 2011, 49 (2): 665-670. 10.1128/JCM.01602-10.CrossRef
18.
Wacker C, Prkno A, Brunkhorst FM, Schlattmann P: Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis. 2013
19.
BalcI C, Sungurtekin H, Gürses E, Sungurtekin U, Kaptanoglu B: Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care. 2003, 7 (1): 85-CrossRefPubMed
20.
Tang BM, Eslick GD, Craig JC, McLean AS: Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis. 2007, 7 (3): 210-217. 10.1016/S1473-3099(07)70052-X.CrossRefPubMed
21.
Bouadma L, Luyt C-E, Tubach F, Cracco C, Alvarez A, Schwebel C, Schortgen F, Lasocki S, Veber B, Dehoux M: Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010, 375 (9713): 463-474. 10.1016/S0140-6736(09)61879-1.CrossRefPubMed
22.
Martini A, Gottin L, Menestrina N, Schweiger V, Simion D, Vincent J-L: Procalcitonin levels in surgical patients at risk of candidemia. J Infect. 2010, 60 (6): 425-430. 10.1016/j.jinf.2010.03.003.CrossRefPubMed
23.
Charles PE, Dalle F, Aho S, Quenot J-P, Doise J-M, Aube H, Olsson N-O, Blettery B: Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients. Intensive Care Med. 2006, 32 (10): 1577-1583. 10.1007/s00134-006-0306-3.CrossRefPubMed
24.
Brodská H, Malíčková K, Adámková V, Benáková H, Sťastná MM, Zima T: Significantly higher procalcitonin levels could differentiate Gram-negative sepsis from Gram-positive and fungal sepsis. Clin Exp Med. 2012, 1-6.
25.
Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008, 34 (1): 17-60. 10.1007/s00134-007-0934-2.CrossRefPubMed
26.
Vincent J-L, De Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S: Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Crit Care Med. 1998, 26 (11): 1793-1800. 10.1097/00003246-199811000-00016.CrossRefPubMed
27.
WJ C: Practical non parametric statistics. 1999, New York: John Wiley & Son, 3
28.
Bassetti M, Mikulska M, Viscoli C: Bench-to-bedside review: Therapeutic management of invasive candidiasis in the intensive care unit. Crit Care. 2010, 14 (6): 244-10.1186/cc9239.CrossRefPubMedPubMedCentral
29.
Fernandez J, Erstad BL, Petty W, Nix DE: Time to positive culture and identification for Candida blood stream infections. Diagn Microbiol Infect Dis. 2009, 64 (4): 402-407. 10.1016/j.diagmicrobio.2009.04.002.CrossRefPubMed
30.
Guery BP, Arendrup MC, Auzinger G, Azoulay É, Sá MB, Johnson EM, Müller E, Putensen C, Rotstein C, Sganga G: Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment. Intensive Care Med. 2009, 35 (2): 206-214. 10.1007/s00134-008-1339-6.CrossRefPubMed
31.
Posteraro B, De Pascale G, Tumbarello M, Torelli R, Pennisi MA, Bello G, Maviglia R, Fadda G, Sanguinetti M, Antonelli M: Early diagnosis of candidemia in intensive care unit patients with sepsis: a prospective comparison of (1 → 3)-β-D-glucan assay, Candida score, and colonization index. Crit Care. 2011, 15 (5): R249-10.1186/cc10507.CrossRefPubMedPubMedCentral
32.
Presterl E, Parschalk B, Bauer E, Lassnigg A, Hajdu S, Graninger W: Invasive fungal infections and (1, 3)-β-D-glucan serum concentrations in long-term intensive care patients. Int J Infect Dis. 2009, 13 (6): 707-712. 10.1016/j.ijid.2008.10.013.CrossRefPubMed
33.
Nakao A, Yasui M, Kawagoe T, Tamura H, Tanaka S, Takagi H: False-positive endotoxemia derives from gauze glucan after hepatectomy for hepatocellular carcinoma with cirrhosis. Hepatogastroenterology. 1997, 44 (17): 1413-1418.PubMed
34.
Karageorgopoulos DE, Vouloumanou EK, Ntziora F, Michalopoulos A, Rafailidis PI, Falagas ME: β-D-glucan assay for the diagnosis of invasive fungal infections: a meta-analysis. Clin Infect Dis. 2011, 52 (6): 750-770. 10.1093/cid/ciq206.CrossRefPubMed
35.
Ellis M, Al-Ramadi B, Bernsen R, Kristensen J, Alizadeh H, Hedstrom U: Prospective evaluation of mannan and anti-mannan antibodies for diagnosis of invasive Candida infections in patients with neutropenic fever. J Med Microbiol. 2009, 58 (5): 606-615. 10.1099/jmm.0.006452-0.CrossRefPubMed
36.
Arendrup M, Bergmann O, Larsson L, Nielsen H, Jarløv J, Christensson B: Detection of candidaemia in patients with and without underlying haematological disease. Clin Microbiol Infect. 2010, 16 (7): 855-862.CrossRefPubMed
37.
Montagna M, Coretti C, Caggiano G: Procalcitonin: a possible marker of invasive fungal infection in high risk patients?. J Prev Med Hyg. 2011, 52 (1): 38-PubMed
38.
Hotchkiss RS, Monneret G, Payen D: Immunosuppression in sepsis: a novel understanding of the disorder and a new therapeutic approach. Lancet Infect Dis. 2013, 13 (3): 260-268. 10.1016/S1473-3099(13)70001-X.CrossRefPubMedPubMedCentral
39.
40.
Chang KC, Burnham C-A, Compton SM, Rasche DP, Mazuski RJ, Macdonough JS, Unsinger J, Korman AJ, Green JM, Hotchkiss RS: Blockade of the negative co-stimulatory molecules PD-1 and CTLA-4 improves survival in primary and secondary fungal sepsis. Crit Care. 2013, 17 (3): R85-10.1186/cc12711.CrossRefPubMedPubMedCentral
41.
Otto GP, Sossdorf M, Claus RA, Rodel J, Menge K, Reinhart K, Bauer M, Riedemann NC: The late phase of sepsis is characterized by an increased microbiological burden and death rate. Crit Care. 2011, 15: R183-10.1186/cc10332.CrossRefPubMedPubMedCentral
42.
Charles PE, Ladoire S, Snauwaert A, Prin S, Aho S, Pechinot A, Olsson N-O, Blettery B, Doise J-M, Quenot J-P: Impact of previous sepsis on the accuracy of procalcitonin for the early diagnosis of blood stream infection in critically ill patients. BMC Infect Dis. 2008, 8 (1): 163-10.1186/1471-2334-8-163.CrossRefPubMedPubMedCentral
43.
Ha YE, Peck KR, Joo E-J, Kim SW, Jung S-I, Chang HH, Park KH, Han SH: Impact of first-line antifungal agents on the outcomes and costs of candidemia. Antimicrob Agents Chemother. 2012, 56 (7): 3950-3956. 10.1128/AAC.06258-11.CrossRefPubMedPubMedCentral
44.
Arendrup MC: Epidemiology of invasive candidiasis. Curr Opin Crit Care. 2010, 16 (5): 445-452. 10.1097/MCC.0b013e32833e84d2.CrossRefPubMed
45.
Arendrup MC, Bruun B, Christensen JJ, Fuursted K, Johansen HK, Kjældgaard P, Knudsen JD, Kristensen L, Møller J, Nielsen L: National surveillance of fungemia in Denmark (2004 to 2009). J Clin Microbiols. 2011, 49 (1): 325-334. 10.1128/JCM.01811-10.CrossRef
46.
Moore LJ, McKinley BA, Turner KL, Todd SR, Sucher JF, Valdivia A, Sailors RM, Kao LS, Moore FA: The epidemiology of sepsis in general surgery patients. J Trauma Acute Care Surg. 2011, 70 (3): 672-680. 10.1097/TA.0b013e31820e7803.CrossRef
47.
Sartelli M, Catena F, Ansaloni L, Moore E, Malangoni M, Velmahos G, Coimbra R, Koike K, Leppaniemi A, Biffl W: Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study). World J Emerg Surg. 2013, 8 (1): 1-10.1186/1749-7922-8-1.CrossRefPubMedPubMedCentral
48.
Eckmann C, Dryden M, Montravers P, Kozlov R, Sganga G: Antimicrobial Treatment of" Complicated" Intra-Abdominal Infections and The New IDSA Guidelines-A Commentary and an Alternative European Approach According to Clinical Definitions. Eur J Med Res. 2011, 16 (3): 115-10.1186/2047-783X-16-3-115.CrossRefPubMedPubMedCentral
Metadata
Title
Procalcitonin as a marker of Candida species detection by blood culture and polymerase chain reaction in septic patients
Authors
Andrea Cortegiani
Vincenzo Russotto
Francesca Montalto
Grazia Foresta
Giuseppe Accurso
Cesira Palmeri
Santi Maurizio Raineri
Antonino Giarratano
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2014
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/1471-2253-14-9

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