Background
Methods
Statistical analysis
Results
Blood culture results
| |||||
Bacteria | Mixed | Negative | Candida | Total | |
N°
| 151 | 31 | 56 | 22 | 260 |
PCR results
| |||||
Bacteria | Mixed | Negative | Candida | Total | |
N°
| 143 | 39 | 48 | 30 | 260 |
Bacteremia (1) | Mixed (2) | Negative (3) | Candida (4) | Overall | P value | |
---|---|---|---|---|---|---|
Diagnostic episodes
| 151 | 31 | 56 | 22 | 260 | |
Age Mean (SD) | 65.3 (13.9) | 67.1 (14.1) | 65.2 (13.4) | 68.8 (11.7) | 65.8 (13.6) | 0.66 |
Sex (male) (%)
| 79 (52.3) | 17 (54.9) | 32 (57.1) | 11 (50) | 139 (53.5) | 0.92 |
WBC (cells x103/μL) Median (I.Q) | 16.1 (14.1-18.2) | 17.2 (14.2-18.3) | 16.1 (13.0-18.1) | 16.9 (14.9 -18.5) | 16.2 (13.9-18.2) | 0.24 |
SOFA Mean (SD) | 7.8 (1.4) | 7.9 (2.1) | 7.6 (1.1) | 8.2 (1.6) | 7.8 (1.5) | 0.5 |
Surgical (%)
| 90 (59.6) | 20 (64.5) | 29 (51.8) 3 vs 4 p = 0.03 | 19 (86.4) 1 vs 4 p = 0.05 | 158 (60.8) | 0.04 |
Septic Shock (%)
| 52 (34.4) | 9 (29) | 15 (26.8) | 7 (31.8) | 83 (31.9) | 0.74 |
Subsequent Diagnostic Episode (%)
| 40 (26.5) | 21 (66.7) 1 vs 2 p = 0.0057 | 15 (26.8) 3 vs 4 p = 0.0048 | 18 (81.8) 1 vs 4 p = 0.0003 | 94 (36.2) | 0.0001 |
Bacteremia (1) | Mixed (2) | Negative (3) | Candida (4) | Overall | P value | |
---|---|---|---|---|---|---|
Diagnostic episodes
| 143 | 39 | 48 | 30 | 260 | |
Age Mean (SD) | 65.2 (13.8) | 67.1 (14.3) | 64.3 (13.1) | 69.2 (11.3) | 65.8 (13.5) | 0.37 |
Sex (male) (%) | 74 (51.7) | 20 (51.3) | 28 (58.3) | 16 (53.3) | 138 (53.1) | 0.87 |
WBC (cells x103/μL) Median (I.Q) | 16.1 (13.9 -18.2) | 16.9 (14.4-18.2) | 16.4 (13.0 -18.1) | 16.7 (14.2 -18.4) | 16.2 (13.9-18.2) | 0.58 |
SOFA Mean (SD) | 7.8 (1.4) | 8.1 (2.0) | 7.6 (1.1) | 8.0 (1.4) | 7.8 (1.5) | 0.3 |
Surgical (%)
| 87 (60.8) | 22 (56.4) | 25 (52.1) | 24 (80.0) | 158 (60.8) | 0.09 |
Septic Shock (%)
| 52 (36.4) | 9 (23.1) | 15 (31.2) | 7 (23.3) | 83 (31.9) | 0.29 |
Subsequent Diagnostic Episode %
| 38 (26.6) | 23 (58.9)1 vs 2 p = 0.02 | 14 (29.2) | 19 (63.3) 1 vs 4 p = 0.02 | 94 (36.2) | 0.0001 |
Group | PCT (ng/ml) Median (I.Q.) | Different (p < 0.05) from |
---|---|---|
Bacteremia
| 16.75 (7.65 - 50.5) | Mixed, Candidemia |
Mixed
| 4.76 (2.98 - 6.08) | Bacteremia, Negative, Candidemia |
Negative
| 12.36 (9.36 - 37.2) | Mixed, Candidemia |
Candidemia
| 0.99 (0.86 - 1.34) | Bacteremia, Mixed, Negative |
Group | PCT (ng/ml) Median (I.Q.) | Different (p < 0.05) from |
---|---|---|
Bacteremia
| 16.54 (7.83 - 47.8) | Mixed, Candidemia |
Mixed
| 6.08 (4.29 - 12.65) | Bacteremia, Negative, Candidemia |
Negative
| 13.4 (9.36 - 41.5) | Mixed, Candidemia |
Candidemia
| 1.27 (0.92 - 2.09) | Bacteremia, Mixed, Negative |
Variable | Variable type | β coefficient | Standard error |
P value
|
---|---|---|---|---|
PCT
| Continuos | -0.41 | 0.07 | < 0.0001 |
Subsequent Diagnostic episode
| Dichotomous | 2.23 | 0.48 | < 0.0001 |
Variable | Variable type | β coefficient | Standard error |
P value
|
---|---|---|---|---|
PCT
| Continuos | -0.07 | 0.016 | < 0.0001 |
Subsequent Diagnostic episode
| Dichotomous | 1.38 | 0.33 | < 0.0001 |
Candida spp | Diagnostic episodes (%) | PCT value Median (I.Q.) |
---|---|---|
C. Albicans
| 13 (59.0) | 1.32 (0.92 - 2.0) |
C. non albicans
| 9 (41.0) | 0.92 (0.68 - 1.98) |
C. Parapsilosis
| 6 (27.3) | 0.90 (0.83 - 1.29) |
C. glabrata
| 1 (4.5) | 2.98 |
C. krusei
| 2 (9.1) | 1.58 (0.12 - 3.05) |
C. tropicalis
| 0 |
Candida spp | Diagnostic episodes (%) | PCT value Median (I.Q.) |
---|---|---|
C. Albicans
| 14 (46.7) | 1.32 (0.97 - 2.29) |
C. non albicans
| 16 (53.3) | 1.08 (0.86 - 1.60) |
C. Parapsilosis
| 10 (33.3) | 0.92 (0.84 - 1.20) |
C. glabrata
| 3 (10) | 2.09 (1.21 - 2.98) |
C. krusei
| 2 (6.7) | 1.58 (0.12 – 3.05) |
C. tropicalis
| 1 (3.3) | 1.56 |
Discussion
Conclusions
Key messages
-
Procalcitonin shows a high negative predictive value for detection of Candida spp. by blood culture or polymerase chain reaction either alone or in a mixed infection with bacteria.
-
Procalcitonin may represent a useful tool for the diagnostic workup of critically ill patients with Candida bloodstream infections.