calca-protein--human and Candidiasis

Although the majority of cases of sepsis in intensive care unit (ICU) patients are due to bacterial infection, fungal infections are common and their early identification is important so that appropriate treatment can be started. Biomarkers have been used to aid diagnosis of bacterial infections, but their role in fungal infections is less defined. In this study we assessed the value of procalcitonin (PCT) levels for the diagnosis of candidemia or bacteremia in septic patients.. We prospectively recorded PCT levels in 48 critically ill surgical patients with signs of sepsis and at high risk for fungal infection, and compared levels in patients with candidemia and bacteremia.. Bacterial species were isolated from blood cultures in 16 patients, Candida species in 17, and mixed bacterial and Candida species in 2 patients. PCT levels were less elevated in patients with candidemia (median 0.71 [IQR 0.5-1.1]) than in those with bacteremia (12.9 [2.6-81.2]). A PCT value less than 2 ng/ml enabled bacteremia to be ruled out with a negative predictive value of 94%, and had a similar positive predictive value for candidemia.. Our data indicate that a low PCT value in a critically ill septic patient is more likely to be related to candidemia than to bacteremia.

Topics: Aged; Bacteremia; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Candida; Candidiasis; Critical Care; Female; Fungemia; Humans; Intensive Care Units; Linear Models; Male; Middle Aged; Prospective Studies; Protein Precursors; Risk Factors; ROC Curve; Statistics, Nonparametric

Invasive candidiasis (IC) outcomes in intensive care units (ICUs) could be improved by the early administration of antifungals. The Candida Score (CS) prediction rule has been proposed for the selection of patients who could develop IC. Procalcitonin (PCT) levels allow prompt identification of sepsis, but their behavior in the setting of IC is unclear. We hypothesize that PCT could be helpful in the early diagnosis of IC in patients with Candida sp. colonization.. Prospective observational study.. Thirty-six ICUs in Spain, Portugal and France.. Every non-neutropenic critically ill patient hospitalized for more than 7 days without concurrent bacterial infection. The CS was calculated weekly. Serums were collected concomitantly.. Two hundred twenty PCT levels were measured in 136 patients [neither colonized nor infected (NCNI): n = 73; multifocal colonization (MF): n = 43; MF + IC: n = 20]. Baseline PCT levels were significantly higher in the MF + IC group than in other groups (p = 0.001). In patients with MF, the highest CS value calculated during the patient's stay was the sole independent predictor of IC. The receiver-operating curve analysis showed that the diagnosis values of PCT and CS were comparable (AUROCC = 0.713, and 0.727, respectively). Moreover, PCT increased the positive predictive value of CS from 44.7 to 59.3%.. After 7 days of hospitalization, PCT levels in patients with MF who go on to develop IC are higher than in others. Serum PCT could also improve the predictive value of CS. PCT together with CS could therefore be considered for the assessment of IC risk.

Topics: Adolescent; Adult; Calcitonin; Calcitonin Gene-Related Peptide; Candidiasis; Critical Illness; Diagnosis, Differential; Female; France; Humans; Male; Middle Aged; Portugal; Prospective Studies; Protein Precursors; Severity of Illness Index; Spain; Young Adult

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.. A medical intensive care unit in a teaching hospital.. 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.. 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.. A high PCT value in a critically ill non-neutropenic patient with clinical sepsis is unlikely in the setting of candidemia.

Topics: Aged; Bacteremia; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Candidiasis; Chi-Square Distribution; Critical Illness; Diagnosis, Differential; Early Diagnosis; Female; Humans; Leukocyte Count; Logistic Models; Male; Middle Aged; Predictive Value of Tests; Protein Precursors; ROC Curve

Procalcitonin (PCT) has been described as a marker of bacterial sepsis. However, little is known of its diagnostic value in fungal infections. We calculated the sensitivity of PCT for detection of invasive fungal infections (IFI) by analyzing 55 episodes of proven or probable IFI (three in our series, 52 reported in the recent literature). In the early phase of IFI, PCT was elevated in fewer than half of invasive candidiasis episodes and in only one patient (5.3%) with invasive aspergillosis. Due to low sensitivity and specificity, PCT adds little to the diagnosis of IFI.

Topics: Adolescent; Aspergillosis; Austria; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Candida albicans; Candidiasis; Child; Female; Fungemia; Humans; Male; Protein Precursors