Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan; Department of Infection Control and Prevention, Wakayama Medical University, Japan.
Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
J Microbiol Immunol Infect. 2021 Dec;54(6):1028-1037. doi: 10.1016/j.jmii.2020.08.015. Epub 2020 Aug 20.
Procalcitonin (PCT) is an early diagnosis marker of sepsis/bacteremia. However, some reports refer to its lower responsiveness to gram-positive bacteremia. We retrospectively evaluated the PCT values at the onset of bacteremia in relation to severity index.
Patients with bacteremia caused by two gram-negative bacteria (46 E. coli and 50 Klebsiella pneumoniae) and three gram-positive bacteria (45 S. aureus, 56 S. epidermidis, and 10 S. mitis) were studied. The plasma PCT and C-reactive protein (CRP) levels were compared between species and different Sequential Organ Failure Assessment (SOFA) score groups.
The median PCT level was higher in gram-negative than in gram-positive bacteremia in overall (13.09 vs. 0.50 ng/mL, p < 0.0001), in SOFA score≥4 group (28.85 vs.1.72 ng/mL, p < 0.0001) and in SOFA<4 group (2.64 vs. 0.42 ng/mL, p < 0.0001). Only 46%, and 11% of patients showed PCT ≥0.5 ng/mL in S. epidermidis, and S. mitis bacteremia, respectively. PCT was significantly better than CRP in discriminating gram-negative from gram-positive bacteremia (AUCROC; 0.828 and 0.634, p < 0.001), but it was low in Staphylococcus epidermidis bacteremia regardless of SOFA scores.
PCT levels are lower in gram-positive bacteremia regardless of SOFA scores or the presence of shock. The conventional sepsis cutoff of 0.5 ng/mL may overlook certain proportions of gram-positive bacteremia.
降钙素原（PCT）是脓毒症/菌血症的早期诊断标志物。然而，一些报告称其对革兰阳性菌血症的反应较低。我们回顾性评估了菌血症发病时 PCT 值与严重程度指数的关系。
研究了由两种革兰氏阴性菌（46 株大肠埃希菌和 50 株肺炎克雷伯菌）和三种革兰氏阳性菌（45 株金黄色葡萄球菌、56 株表皮葡萄球菌和 10 株米氏链球菌）引起的菌血症患者。比较了不同种属和不同序贯器官衰竭评估（SOFA）评分组之间的血浆 PCT 和 C 反应蛋白（CRP）水平。
总体而言，革兰氏阴性菌血症的 PCT 中位数高于革兰氏阳性菌血症（13.09 与 0.50ng/mL，p<0.0001），SOFA 评分≥4 组（28.85 与 1.72ng/mL，p<0.0001）和 SOFA<4 组（2.64 与 0.42ng/mL，p<0.0001）。在表皮葡萄球菌和米氏链球菌血症中，仅 46%和 11%的患者 PCT≥0.5ng/mL。PCT 在鉴别革兰氏阴性菌和革兰氏阳性菌血症方面明显优于 CRP（AUCROC；0.828 和 0.634，p<0.001），但在 SOFA 评分无论如何，表皮葡萄球菌血症中的 PCT 均较低。
无论 SOFA 评分或休克存在与否，革兰氏阳性菌血症中的 PCT 水平均较低。传统的 0.5ng/mL 败血症截断值可能会忽略某些比例的革兰氏阳性菌血症。
