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Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Septicemia | Research

Procalcitonin levels in candidemia versus bacteremia: a systematic review

Authors: Andrea Cortegiani, Giovanni Misseri, Mariachiara Ippolito, Matteo Bassetti, Antonino Giarratano, Ignacio Martin-Loeches, Sharon Einav

Published in: Critical Care | Issue 1/2019

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Abstract

Background

Procalcitonin (PCT) is a biomarker used to assess systemic inflammation, infection, and sepsis and to optimize antimicrobial therapies. Its role in the in the differential diagnosis between candidemia and bacteremia is unclear. The aim of this systematic review was to summarize the current evidence about PCT values for differentiating candidemia from bacteremia.

Methods

PubMed and EMBASE were searched for studies reporting data on the diagnostic performance of serum PCT levels in intensive care unit (ICU) or non-ICU adult patients with candidemia, in comparison to patients with bacteremia.

Results

We included 16 studies for a total of 45.079 patients and 785 cases of candidemia. Most studies claimed to report data relating to the use of PCT values for differentiating between candidemia and bacteremia in septic patients in the intensive care unit. However, the studies identified were all retrospective, except for one secondary analysis of a prospective dataset, and clinically very heterogeneous and involved different assessment methods. Most studies did show lower PCT values in patients with candidemia compared to bacteremia. However, the evidence supporting this observation is of low quality and the difference seems insufficiently discriminative to guide therapeutic decisions. None of the studies retrieved actually studied guidance of antifungal treatment by PCT. PCT may improve diagnostic performance regarding candidemia when combined with other biomarkers of infection (e.g., beta-d-glucan) but more data is needed.

Conclusions

PCT should not be used as a standalone tool for the differential diagnosis between candidemia and bacteremia due to limited supporting evidence.
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Metadata
Title
Procalcitonin levels in candidemia versus bacteremia: a systematic review
Authors
Andrea Cortegiani
Giovanni Misseri
Mariachiara Ippolito
Matteo Bassetti
Antonino Giarratano
Ignacio Martin-Loeches
Sharon Einav
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2481-y

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