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Open Access 01-12-2010 | Research

Procalcitonin reflects bacteremia and bacterial load in urosepsis syndrome: a prospective observational study

Authors: Cees van Nieuwkoop, Tobias N Bonten, Jan W van't Wout, Ed J Kuijper, Geert H Groeneveld, Martin J Becker, Ted Koster, G Hanke Wattel-Louis, Nathalie M Delfos, Hans C Ablij, Eliane MS Leyten, Jaap T van Dissel

Published in: Critical Care | Issue 6/2010

Abstract

Introduction

Guidelines recommend that two blood cultures be performed in patients with febrile urinary tract infection (UTI), to detect bacteremia and help diagnose urosepsis. The usefulness and cost-effectiveness of this practice have been criticized. This study aimed to evaluate clinical characteristics and the biomarker procalcitonin (PCT) as an aid in predicting bacteremia.

Methods

A prospective observational multicenter cohort study included consecutive adults with febrile UTI in 35 primary care units and 8 emergency departments of 7 regional hospitals. Clinical and microbiological data were collected and PCT and time to positivity (TTP) of blood culture were measured.

Results

Of 581 evaluable patients, 136 (23%) had bacteremia. The median age was 66 years (interquartile range 46 to 78 years) and 219 (38%) were male. We evaluated three different models: a clinical model including seven bed-side characteristics, the clinical model plus PCT, and a PCT only model. The diagnostic abilities of these models as reflected by area under the curve of the receiver operating characteristic were 0.71 (95% confidence interval (CI): 0.66 to 0.76), 0.79 (95% CI: 0.75 to 0.83) and 0.73 (95% CI: 0.68 to 0.77) respectively. Calculating corresponding sensitivity and specificity for the presence of bacteremia after each step of adding a significant predictor in the model yielded that the PCT > 0.25 μg/l only model had the best diagnostic performance (sensitivity 0.95; 95% CI: 0.89 to 0.98, specificity 0.50; 95% CI: 0.46 to 0.55). Using PCT as a single decision tool, this would result in 40% fewer blood cultures being taken, while still identifying 94 to 99% of patients with bacteremia.

The TTP of E. coli positive blood cultures was linearly correlated with the PCT log value; the higher the PCT the shorter the TTP (R² = 0.278, P = 0.007).

Conclusions

PCT accurately predicts the presence of bacteremia and bacterial load in patients with febrile UTI. This may be a helpful biomarker to limit use of blood culture resources.

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Title: Procalcitonin reflects bacteremia and bacterial load in urosepsis syndrome: a prospective observational study
Authors: Cees van Nieuwkoop
Tobias N Bonten
Jan W van't Wout
Ed J Kuijper
Geert H Groeneveld
Martin J Becker
Ted Koster
G Hanke Wattel-Louis
Nathalie M Delfos
Hans C Ablij
Eliane MS Leyten
Jaap T van Dissel
Publication date: 01-12-2010
Publisher: BioMed Central
Published in: Critical Care / Issue 6/2010
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc9328

ACC 2024 Congress

Springer Medicine

Procalcitonin reflects bacteremia and bacterial load in urosepsis syndrome: a prospective observational study

Abstract

Introduction

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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