Procalcitonin levels in candidemia versus bacteremia: a systematic review.

Adult Bacteremia / blood Biomarkers / analysis Candidemia / blood Female Humans Male Procalcitonin / analysis
Biomarker Candida Candidemia Fungal Fungi PCT Procalcitonin Sepsis

Journal

Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902

Informations de publication

Date de publication:
28 May 2019
Historique:
received: 08 03 2019
accepted: 19 05 2019
entrez: 30 5 2019
pubmed: 30 5 2019
medline: 20 12 2019
Statut: epublish

Résumé

Procalcitonin (PCT) is a biomarker used to assess systemic inflammation, infection, and sepsis and to optimize antimicrobial therapies. Its role in the in the differential diagnosis between candidemia and bacteremia is unclear. The aim of this systematic review was to summarize the current evidence about PCT values for differentiating candidemia from bacteremia. PubMed and EMBASE were searched for studies reporting data on the diagnostic performance of serum PCT levels in intensive care unit (ICU) or non-ICU adult patients with candidemia, in comparison to patients with bacteremia. We included 16 studies for a total of 45.079 patients and 785 cases of candidemia. Most studies claimed to report data relating to the use of PCT values for differentiating between candidemia and bacteremia in septic patients in the intensive care unit. However, the studies identified were all retrospective, except for one secondary analysis of a prospective dataset, and clinically very heterogeneous and involved different assessment methods. Most studies did show lower PCT values in patients with candidemia compared to bacteremia. However, the evidence supporting this observation is of low quality and the difference seems insufficiently discriminative to guide therapeutic decisions. None of the studies retrieved actually studied guidance of antifungal treatment by PCT. PCT may improve diagnostic performance regarding candidemia when combined with other biomarkers of infection (e.g., beta-D-glucan) but more data is needed. PCT should not be used as a standalone tool for the differential diagnosis between candidemia and bacteremia due to limited supporting evidence.

Sections du résumé

BACKGROUND BACKGROUND
Procalcitonin (PCT) is a biomarker used to assess systemic inflammation, infection, and sepsis and to optimize antimicrobial therapies. Its role in the in the differential diagnosis between candidemia and bacteremia is unclear. The aim of this systematic review was to summarize the current evidence about PCT values for differentiating candidemia from bacteremia.
METHODS METHODS
PubMed and EMBASE were searched for studies reporting data on the diagnostic performance of serum PCT levels in intensive care unit (ICU) or non-ICU adult patients with candidemia, in comparison to patients with bacteremia.
RESULTS RESULTS
We included 16 studies for a total of 45.079 patients and 785 cases of candidemia. Most studies claimed to report data relating to the use of PCT values for differentiating between candidemia and bacteremia in septic patients in the intensive care unit. However, the studies identified were all retrospective, except for one secondary analysis of a prospective dataset, and clinically very heterogeneous and involved different assessment methods. Most studies did show lower PCT values in patients with candidemia compared to bacteremia. However, the evidence supporting this observation is of low quality and the difference seems insufficiently discriminative to guide therapeutic decisions. None of the studies retrieved actually studied guidance of antifungal treatment by PCT. PCT may improve diagnostic performance regarding candidemia when combined with other biomarkers of infection (e.g., beta-D-glucan) but more data is needed.
CONCLUSIONS CONCLUSIONS
PCT should not be used as a standalone tool for the differential diagnosis between candidemia and bacteremia due to limited supporting evidence.

Identifiants

DOI: 10.1186/s13054-019-2481-y PMID: 31138262 PMC: PMC6537202
pubmed: 31138262
doi: 10.1186/s13054-019-2481-y
pii: 10.1186/s13054-019-2481-y
pmc: PMC6537202
doi:

Substances chimiques

Biomarkers 0
Procalcitonin 0

Types de publication

Journal Article Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

190

Commentaires et corrections

Type : CommentIn
Type : ErratumIn
Type : CommentIn

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Auteurs

Andrea Cortegiani (A)

Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, via del vespro 129, 90127, Palermo, Italy. cortegiania@gmail.com.
ORCID: 0000-0003-1416-9993

Giovanni Misseri (G)

Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, via del vespro 129, 90127, Palermo, Italy.

Mariachiara Ippolito (M)

Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, via del vespro 129, 90127, Palermo, Italy.

Matteo Bassetti (M)

Infectious Diseases Division, Department of Medicine, University of Udine and Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia 15, Udine, Italy.

Antonino Giarratano (A)

Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, via del vespro 129, 90127, Palermo, Italy.

Ignacio Martin-Loeches (I)

Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland.
Hospital Clinic, Universidad de Barcelona, CIBERes, Barcelona, Spain.

Sharon Einav (S)

Intensive Care Unit of the Shaare Zedek Medical Medical Centre and Hebrew University Faculty of Medicine, Jerusalem, Israel.

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questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Inflammation › Sepsie › Bactériémie › Procalcitonin levels in candidemia versus...
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questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Inflammation › Sepsie › Fongémie › Candidémie › Procalcitonin levels in candidemia versus...
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