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Usefulness of plasma procalcitonin as a predictor of bacteremia due to Gram-negative microorganisms
Utilidad de la procalcitonina plasmática como factor predictor de bacteriemias por microorganismos gramnegativos
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PCT: procalcitonin.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Procalcitonin (PCT) is a plasma biomarker synthesised in the cells of the thyroid gland and in the neuroendocrine tissue of the lungs. Sepsis may increase its production, so the higher the level, the greater the likelihood of systemic bacterial infection.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Plasma PCT concentrations greater than 0.25 ng/mL can be considered positive and antibiotic treatment is recommended if these values are greater than 0.5 ng/mL. Conversely, when these values are less than 0.25 ng/mL, the likelihood of bacterial infection is low, which would advise against the administration of antibiotic treatment, with cessation recommended when the values have fallen below 0.1 ng/mL.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Based on these premises and in the light of other scientific publications on the subject,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> we decided to evaluate whether plasma PCT levels could be different depending on the micro-organism causing the condition, hypothesising that gram-negative (GN) micro-organisms increase plasma PCT levels more than gram-positive (GP) micro-organisms. For this purpose, we conducted an observational and retrospective cohort study of episodes of bacteraemia recorded in patients admitted during the month of June 2021 in the Internal Medicine Department of the Hospital Clínico San Carlos in Madrid. Clinical, microbiological, laboratory and therapeutic variables were analysed. Isolation of the same micro-organism in 2 blood cultures or a positive blood culture of a micro-organism other than coagulase negative <span class="elsevierStyleItalic">Staphylococcus</span> was considered significant bacteraemia. Plasma white blood cell, lactate, C-reactive protein (CRP) and PCT values in the first 24 h of admission were compared between GN versus GP bacteraemia. A receiver operator characteristics (ROC) curve was performed to assess the usefulness of the independent variable PCT to distinguish the group of bacteraemia caused by GN and GP. Discrimination was quantified by calculating the area under the curve (ABC) and its respective confidence interval (CI). A p-value of <span class="elsevierStyleItalic">P</span> < .05 was considered statistically significant. Data analysis was performed using the statistical software IBM® SPSS® Statistics v. 26.0.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A total of 49 episodes of bacteraemia were recorded during the period, of which 59.1% were significant bacteraemia (n = 29). 58.6% were women with a mean age of 78.8 years (min. 62–max. 95). GN bacteraemia (51.7 vs 37.9%) was more common than GP bacteraemia. The main focus was urinary (41.4%), and the most common microorganisms were: <span class="elsevierStyleItalic">Escherichia coli</span> (31%), <span class="elsevierStyleItalic">Klebsiella pneumoniae</span> (13.8%) and <span class="elsevierStyleItalic">Enterococcus faecium</span> (6.9%). The median laboratory values on admission were: lactate 1.9 mmol/l, white blood cells 9.800/mm<span class="elsevierStyleSup">3</span>, CRP 5.5 mg/l, PCT 5.6 ng/mL, creatinine 1.06 mg/dl. The most commonly used antibiotics, alone or in combination, in order of frequency were: amoxicillin-clavulanate (17.2%), piperacillin-tazobactam (13.8%), ceftazidime/avibactam + tigecycline (13.8%), ceftriaxone (10.3%) and meropenem + amikacin (6.9%). After microbiological isolation, initial antibiotic treatment was maintained in one third of patients. Mortality during admission was 35.7%. The mean PCT value was statistically significantly higher in GN bacteraemia compared to GP bacteraemia (9.3 vs. 1.8; <span class="elsevierStyleItalic">P</span> = .02). There were no significant differences between groups in the mean values of white blood cells (11,892.8 vs. 10,254.5; <span class="elsevierStyleItalic">P</span> = .54), lactate (2.5 vs. 1.8; <span class="elsevierStyleItalic">P</span> = .18) and CRP (32.3 vs. 24.1; <span class="elsevierStyleItalic">P</span> = .24). Using ROC curve analysis, the ABC of PCT for differentiating GN versus GP bacteraemia was 78% (95% CI 0.591−0.969; <span class="elsevierStyleItalic">P</span> = .02), with an optimal cut-off point of 1.14 ng/mL (sensitivity 73.3%, specificity 80%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Statistical significance was not reached for CRP (95% CI 0.334−0.840; <span class="elsevierStyleItalic">P</span> = .51), white blood cell (95% CI 0.323−0.851; <span class="elsevierStyleItalic">P</span> = ,51) y lactate (IC 95% 0,455–0,939; <span class="elsevierStyleItalic">P</span> = ,13) levels. We can conclude that plasma PCT levels on admission differ according to the type of bacteraemia, being statistically significantly higher in patients with GN bacteraemia than in those with GP bacteraemia. No differences were found for CRP, white blood cell and lactate levels according to the type of bacteraemia. Importantly, there is a cut-off point at which GN bacteraemia can be predicted with high confidence, which can translate into a more accurate diagnostic and therapeutic approach. Our results were obtained based on the analysis of a cohort of patients with bacteraemia in a short period of time. Larger scale studies are needed to confirm these findings.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study was conducted in accordance with the ethical precepts of the Declaration of Helsinki.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">No conflict of interest exists.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 903 "Ancho" => 1675 "Tamanyo" => 95247 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Predictive capacity of gram-negative bacteraemia according to plasma biomarker levels at 24 h of admission.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CRP: C-reactive protein; PCT: procalcitonin.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Procalcitonin assay in systemic inflammation, infection, and sepsis: clinical utility and limitations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.L. 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