Background
Methods
Study design
Study population
Data collection and laboratory diagnostics
Data analysis
Results
Patient population
Procalcitonin measured | Blood cultures drawn before or after first dose of antibiotics | Total | ||
---|---|---|---|---|
No | Yes, before | Yes, after | ||
No | 254 | 281 | 156 | 691 |
Yes | 1012 |
3157
|
1701
| 5870 |
Total | 1266 | 3438 | 1857 | 6561 |
Characteristic | All patients (n = 4858) | Blood culture results | ||
---|---|---|---|---|
Negative or contamination (n = 2875) | Positive with pathogen (n = 1983) | p value | ||
Age (years) | 70 (59–77) | 70 (59–77) | 70 (59–77) | 0.37 |
Sex (male) | 3060 (63) | 1817 (63) | 1243 (63) | 0.71 |
Origin of infection | < 0.001 | |||
Community acquired | 2136 (44.0) | 1172 (39.6) | 964 (46.5) | |
Nosocomial (ICU) | 1005 (20.7) | 644 (24.0) | 361 (19.2) | |
Nosocomial (ward) | 1579 (32.5) | 990 (34.6) | 589 (31.1) | |
Nosocomial (nursing home) | 138 (2.8) | 69 (1.8) | 69 (3.2) | |
Focus of infection | ||||
Respiratory | 2035 (41.9) | 1386 (48.2) | 649 (32.7) | < 0.001 |
Abdominal | 1632 (33.6) | 1040 (36.2) | 592 (29.9) | < 0.001 |
Urogenital | 744 (15.3) | 288 (10.0) | 456 (23.0) | < 0.001 |
Bones/soft tissue | 565 (11.6) | 282 (9.8) | 283 (14.3) | < 0.001 |
Other | 673 (13.9) | 300 (10.4) | 373 (18.8) | < 0.001 |
Clinical data and scores | ||||
PCT (ng/ml) | 6.4 (1.7–25.6) | 4.1 (1.2–15.5) | 12.6 (3.3–41.9) | < 0.001 |
CRP (mg/ml) | 208 (116–301) | 196 (111–293) | 219 (125–310) | < 0.001 |
WBC (109) | 16.3 (10.7–23.5) | 16.1 (10.9–23.1) | 16.4 (10.2–23.8) | 0.85 |
Leukopenia (WBC ≤ 4) | 545 (11.2) | 281 (9.8) | 264 (13.3) | < 0.001 |
Temperature (°C) | 38.0 (36.3–38.8) | 37.9 (36.0–38.7) | 38.2 (36.8–39.0) | < 0.001 |
Lactate (mmol/l) | 2.7 (1.6–5.0) | 2.6 (1.5–4.7) | 3.0 (1.7–5.5) | < 0.001 |
Urine output (ml/24 h) | 1390 (620–2350) | 1420 (660–2430) | 1320 (580–2300) | 0.02 |
SOFA | 9 (7–12) | 9 (7–11) | 10 (7–12) | < 0.001 |
Septic shocka | 2714 (55.9) | 1577 (54.9) | 1137 (57.3) | 0.09 |
Mortality | ||||
ICU mortality | 1485 (30.6) | 872 (30.4) | 613 (30.9) | 0.68 |
28-Day mortality | 1562 (33.0) | 888 (31.7) | 674 (34.8) | 0.03 |
Hospital mortality | 1861 (38.4) | 1080 (37.6) | 781 (39.4) | 0.21 |
Prediction of Gram-negative bacteremia
Classification | Optimal cutoff (ng/ml) | SENS | SPEC | PPV | NPV | PLR | NLR | ACC |
---|---|---|---|---|---|---|---|---|
Gram-negative bacteremia vs Gram-positive/candidemia | 17.5 | 0.59 | 0.70 | 0.61 | 0.68 | 1.98 | 0.59 | 0.65 |
Gram-negative bacteremia vs all other blood culture results | 10 | 0.69 | 0.65 | 0.33 | 0.9 | 1.97 | 0.47 | 0.66 |
Pathogen species, foci of infection and PCT concentrations
Pathogen species detected from blood cultures | Number | PCT (IQR) | p value |
---|---|---|---|
Staphylococcus
spp.
| 574 | 5.6 (1.9–17.7) | 0.015 |
Staphylococcus aureus, methicillin sensitive | 272 | 7.2 (2.7–20.7) | |
Staphylococcus aureus, methicillin resistant | 58 | 4.7 (1.4–10.6) | |
Coagulase-negative Staphylococci, methicillin sensitive | 151 | 5.2 (1.4–16.1) | |
Coagulase-negative Staphylococci, methicillin resistant | 65 | 3.8 (1.3–12.8) | |
Streptococcus
spp.
| 153 | 18.2 (6.2–44.1) | 0.12 |
Streptococci, Group A, B, C or G | 59 | 18.2 (8.4–47.3) | |
Streptococcus pneumoniae | 63 | 21.6 (7–48.3) | |
Other Streptococci (Streptococcus mutans, other viridans Streptococci) | 26 | 6.8 (3.6–44.1) | |
Enterococcus
spp.
| 128 | 6.8 (2.2–27.8) | 0.5 |
Enterococcus faecalis | 41 | 8.7 (2.1–54) | |
Enterococcus faecium | 71 | 6.7 (2.3–25.3) | |
Vancomycin-resistant Enterococci | 7 | 1.9 (0.5–99.3) | |
Escherichia coli
| 436 | 26.8 (9.8–70) | |
Enterobacteriaceae
other than
E. coli
| 249 | 24.9 (7.6–57.1) | 0.07 |
Enterobacter spp. | 38 | 21.1 (7.6–56.8) | |
Klebsiella spp. | 123 | 21.5 (6–49.7) | |
Proteus spp. | 47 | 46.8 (9.1–97.6) | |
Serratia spp. | 20 | 12.1 (6.5–42.4) | |
Citrobacter spp. | 9 | 37.8 (15.1–113.1) | |
Enterobacteriaceae, other | 2 | 3.7 (2.4–5) | |
Pseudomonas
spp.
| 35 | 5.9 (2.1–28.4) | 0.4 |
Pseudomonas aeruginosa | 32 | 6.1 (3.1–30.6) | |
Pseudomonas, other | 3 | 2.0 (0.6–28.4) | |
Candida spp.
| 68 | 4.7 (2–14) | 0.7 |
Candida albicans | 57 | 5.3 (2.1–15.3) | |
Candida, other | 37 | 6.5 (2.2–17.4) | |
Rare pathogens
| |||
Listeria monocytogenes | 7 | 8.0 (0.8–19.7) | |
Acinetobacter spp. | 7 | 5.8 (0.9–39.0) | |
Haemophilus spp. | 4 | 29.9 (17.3–36.6) |
Variable | Regression coefficient | 95% CI | p value | Multiplier (95% CI) |
---|---|---|---|---|
Staphylococcus spp. | 0.00 | (− 0.22 to 0.21) | 1.0 | 1.0 (0.6–1.6) |
Streptococcus spp. | 0.50 | (0.26–0.74) | < 0.001 | 3.2 (1.8–5.5) |
Enterococcus spp. | 0.06 | (−0.18 to 0.31) | 0.6 | 1.1 (0.7–2.0) |
Escherichia coli
| 0.50 | (0.29–0.72) | < 0.001 | 3.2 (1.9–5.2) |
Enterobacteriaceae, other | 0.49 | (0.26–0.72) | < 0.001 | 3.1 (1.8–5.2) |
Pseudomonas spp. | 0.04 | (− 0.3 to 0.37) | 0.8 | 1.1 (0.5–2.3) |
Candida spp. | Reference | Reference | ||
Respiratory | − 0.01 | (− 0.14 to 0.12) | 0.9 | 1 (0.7–1.3) |
Abdominal | 0.27 | (0.14–0.41) | < 0.001 | 1.9 (1.4–2.6) |
Urogenital | 0.32 | (0.17–0.47) | < 0.001 | 2.1 (1.5–3.0) |
Bones/soft tissue | Reference | Reference | ||
Intercept | 0.63 | (0.41–0.86) | < 0.001 | 4.3 (2.6–7.2) |
Variable | Regressioncoefficient | 95% CI | p value | Multiplier (95% CI) |
---|---|---|---|---|
Staphylococcus spp. | 0.13 | (0.06–0.2) | < 0.001 | 1.4 (1.2–1.6) |
Streptococcus spp. | 0.59 | (0.47–0.71) | < 0.001 | 3.9 (3.0–5.1) |
Enterococcus spp | 0.17 | (0.03–0.29) | 0.01 | 1.5 (1.1–2.0) |
Escherichia coli
| 0.62 | (0.54–0.7) | < 0.001 | 4.2 (3.5–5.) |
Enterobacteriaceae, other | 0.56 | (0.46–0.65) | < 0.001 | 3.7 (2.9–4.6) |
Pseudomonas spp. | 0.23 | (− 0.02 to 0.47) | 0.07 | 1.7 (1.0–2.9) |
Candida spp. | 0.07 | (− 0.11 to 0.24) | 0.44 | 1.2 (0.8–1.8) |
Several pathogens | 0.46 | (0.36–0.56) | < 0.001 | 2.9 (2.3–3.7) |
Rare pathogens | 0.28 | (0.16–0.4) | < 0.001 | 1.9 (1.5–2.6) |
No pathogen detected | Reference | Reference | ||
Respiratory | −0.24 | (− 0.32 to – 0.16) | < 0.001 | 0.6 (0.5–0.7) |
Abdominal | 0.14 | (0.06–0.22) | < 0.001 | 1.5 (1.3–1.8) |
Urogenital | 0.18 | (0.08–0.27) | < 0.001 | 1.6 (1.3–2.0) |
Bones/soft tissue | − 0.17 | (− 0.27 to – 0.07) | < 0.001 | 0.8 (0.6–1.0) |
Several foci | −0.13 | (− 0.22 to – 0.04) | < 0.001 | 0.8 (0.7–1.0) |
Other/unknown | Reference | Reference | ||
Intercept | 0.70 | (0.62–0.77) | < 0.001 | 4.5 (3.9–5.3) |
Variable | Regression coefficient | 95% CI | p value | Multiplier (95% CI) |
---|---|---|---|---|
Staphylococcus spp. | 0.11 | (0.05–0.18) | <.001 | 1.3 (1.1–1.5) |
Streptococcus spp. | 0.50 | (0.39–0.62) | <.001 | 3.2 (2.5–4.2) |
Enterococcus spp. | 0.14 | (0.02–0.26) | 0.02 | 1.4 (1.0–1.8) |
Escherichia coli
| 0.52 | (0.45–0.59) | <.001 | 3.3 (2.8–3.9) |
Enterobacteriacae, other | 0.51 | (0.42–0.6) | <.001 | 3.2 (2.6–4.0) |
Pseudomonas spp. | 0.16 | (−0.06 to 0.39) | 0.16 | 1.4 (0.9–2.5) |
Candida spp. | 0.14 | (− 0.03 to 0.31) | 0.11 | 1.4 (0.9–2.0) |
Several pathogens | 0.36 | (0.26–0.46) | <.001 | 2.3 (1.8–2.9) |
Rare pathogens | 0.20 | (0.08–0.32) | <.001 | 1.6 (1.2–2.1) |
No pathogen detected | Reference | Reference | ||
Respiratory | −0.24 | (−0.31 to – 0.16) | <.001 | 0.6 (0.5–0.7) |
Abdominal | 0.09 | (0.01–0.17) | <.001 | 1.2 (1.0–1.5) |
Urogenital | 0.20 | (0.11–0.3) | 0.02 | 1.6 (1.3–2.0) |
Bones/soft tissue | −0.19 | (− 0.28 to – 0.1) | <.001 | 0.6 (0.5–0.8) |
Several foci | − 0.10 | (− 0.19 to – 0.02) | <.001 | 0.8 (0.6–1.0) |
Other/unknown | Reference | Reference | ||
Male | 0.06 | (0.02–0.1) | 0.002 | 1.1 (1.0–1.3) |
Female | Reference | Reference | ||
Community acquired | 0.16 | (0.11–0.2) | <.001 | 1.4 (1.3–1.6) |
ICU acquired | −0.14 | (−0.2 to – 0.09) | <.001 | 0.7 (0.6–0.8) |
Normal ward acquired | Reference | Reference | ||
Lactate per mmol/l | 0.01 | (0.01–0.02) | <.001 | 1.0 (1.0–1.0) |
SOFA score per point | 0.03 | (0.02–0.04) | <.001 | 1.1 (1.0–1.1) |
Septic shock | 0.22 | (0.18–0.27) | <.001 | 1.7 (1.5–1.9) |
Intercept | 0.66 | (0.57–0.74) | <.001 | 4.5 (3.7–5.5) |