Charles Pierre Emmanuel, Dalle Frédéric, Aho Serge, Quenot Jean-Pierre, Doise Jean-Marc, Aube Hervé, Olsson Nils-Olivier, Blettery Bernard
Hôpital Le Bocage, Service de Réanimation Médicale, CHU de Dijon, France.
Intensive Care Med. 2006 Oct;32(10):1577-83. doi: 10.1007/s00134-006-0306-3. Epub 2006 Aug 8.
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.
念珠菌血症是重症监护病房中一种危及生命的感染，其预后高度依赖于被识别的阶段。降钙素原（PCT）水平已被证明能准确区分有脓毒症临床体征的重症患者的菌血症和非感染性炎症状态。在这种情况下，PCT用于诊断念珠菌血症的准确性知之甚少。
一家教学医院的内科重症监护病房。
回顾2004年5月至2005年12月期间每例有菌血症或念珠菌血症且伴有临床脓毒症的非中性粒细胞减少患者的病历，这些患者在感染发作时可获得PCT剂量。
纳入了35例菌血症或15例念珠菌血症患者共50次发作。发现菌血症患者的PCT水平明显高于念珠菌血症患者。此外，低PCT值被发现是研究人群中念珠菌血症的独立预测因素。根据受试者工作特征曲线下面积的计算，发现PCT在区分念珠菌血症和菌血症方面是准确的（0.96[0.03]）。PCT水平高于5.5 ng/ml对念珠菌血症相关脓毒症的阴性预测值为100%，阳性预测值为65.2%。
在有临床脓毒症的重症非中性粒细胞减少患者中，念珠菌血症不太可能出现高PCT值。
