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Inicio Enfermedades Infecciosas y Microbiología Clínica (English Edition) Ability of procalcitonin to differentiate true bacteraemia from contaminated blo...
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Original article
DOI: 10.1016/j.eimce.2019.06.002
Available online 16 June 2019
Ability of procalcitonin to differentiate true bacteraemia from contaminated blood cultures in an emergency department
Capacidad de la procalcitonina para diferenciar bacteriemia verdadera de los hemocultivos contaminados en el servicio de urgencias
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Sadaf Zafar Iqbal-Mirzaa, Vicente Serrano Romero de Ávilaa, Raquel Estévez-Gonzáleza, Dara Rodríguez-Gonzálezb, Eva Heredero-Gálvezc, Agustín Julián-Jiménezd,e,
Corresponding author
a Servicio de Medicina Interna, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
b Servicio de Análisis Clínicos y Bioquímica, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
c Servicio de Microbiología, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
d Servicio de Urgencias, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
e Universidad de Castilla La Mancha, Toledo, Spain
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Table 1. Microbiological characteristics of the overall sample according to the type of isolation (true bacteraemia vs contaminated blood cultures).
Table 2. Focus/presumptive clinical diagnosis in the emergency department of the overall sample according to the type of isolation (true bacteraemia vs contaminated blood cultures).
Table 3. Focus/final clinical diagnosis after discharge from the emergency department or from hospitalisation of the contaminated blood culture cases.
Table 4. Clinicoepidemiological characteristics of progression and destination of the overall sample and univariate study according to the type of isolation (true bacteraemia vs contaminated blood cultures).
Table 5. Analytical characteristics of the global sample and univariate study according to the type of isolation (true bacteraemia vs contaminated blood cultures).
Table 6. Cut-off points and performance for predicting true bacteraemia in blood cultures drawn in emergency departments with positive isolation.
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Abstract
Objectives

To analyse and compare the ability of procalcitonin (PCT), C-reactive protein (CRP) and leukocytes to differentiate true bacteraemia from contaminated blood cultures in patients seen in the emergency department (ED) for an episode of infectious disease.

Methods

Observational, retrospective and descriptive analytical study of all blood cultures with positive growth extracted in an ED in adult patients (≥18 years) during 2016 and 2017. The follow-up was carried out over a 30-day period to calculate the predictive power and the prognostic performance for true bacteraemia.

Results

A total of 266 blood cultures with positive growth were included in the study. Out of these, 154 (57.9%) were considered true bacteraemia and 112 (42.1%) were considered to be contaminated blood cultures. The area under the Receiver Operating Characteristic curve (AUC-ROC) for PCT to predict true bacteraemia was 0.983 (95% CI: 0.972–0.994; p<0.001) and, considering a cut-off value of ≥0.43ng/ml, PCT achieved 94% sensitivity, 91% specificity, positive predictive value of 94%, and negative predictive value of 92%. The AUC-ROC obtained for CRP was 0.639 (95% CI: 0.572–0.707, p<0.001), for leukocytes of 0.693 (95% CI: 0.630–0.756, p<0.001) and for immature leukocytes (>10% bands) of 0.614 (95% CI: 0.547–0.682, p<0.001). The mean values for PCT were 3.44 (SD 6.30)ng/ml in true bacteraemia vs 0.16 (SD 0.18)ng/ml in contaminated blood cultures (p<0.001).

Conclusions

In blood cultures with positive growth extracted in an ED, PCT achieves the best prognostic performance of true bacteraemia vs contaminated blood cultures, better than CRP and leukocytes.

Keywords:
Emergency department
Bacteraemia
Blood cultures
Mortality
Biomarkers
Procalcitonin
C-reactive protein
Contaminated blood cultures
Resumen
Objetivos

Analizar y comparar la capacidad de la procalcitonina (PCT), proteína C reactiva (PCR) y leucocitos para diferenciar la bacteriemia verdadera de los hemocultivos (HC) contaminados en los pacientes atendidos en el servicio de urgencias (SU) por un episodio de infección.

Métodos

Estudio observacional, retrospectivo y analítico de todos los HC con crecimiento positivo extraídos en un SU en los pacientes adultos (≥18 años) durante los años 2016 y 2017. Se realizó seguimiento durante 30 días y se calculó el poder y rendimiento pronóstico de bacteriemia verdadera.

Resultados

Se incluyeron 266 casos de HC con crecimiento positivo. De ellos se consideraron como bacteriemias verdaderas 154 (57,9%) y como HC contaminantes 112 (42,1%). Para la predicción de bacteriemia verdadera la PCT obtiene un área bajo la curva Receiver Operating Characteristic (ABC-ROC) de 0,983 (IC 95%: 0,972-0,994; p<0,001) y con un punto de corte de PCT0,43ng/ml se consigue una sensibilidad del 94%, una especificidad del 91%, un valor predictivo positivo de 94% y un valor predictivo negativo de 92%. El ABC-ROC obtenida para la PCR fue de 0,639 (IC 95%: 0,572-0,707; p<0,001), para el recuento de leucocitos de 0,693 (IC 95%: 0,630-0,756; p<0,001) y para las formas inmaduras (>10% cayados) de 0,614 (IC 95%: 0,547-0,682; p=0,001). Los valores medios al comparar la PCT en las bacteriemias verdaderas y los HC contaminados fueron de 3,44ng/ml (DE 6,30) frente a 0,16ng/ml (DE 0,18), p<0,001.

Conclusiones

En los HC con crecimiento positivo extraídos en el SU la PCT consigue el mejor rendimiento pronóstico de bacteriemia verdadera diferenciándola de los HC contaminados, mayor que la PCR y los leucocitos.

Palabras clave:
Servicio de urgencias
Bacteriemia
Hemocultivos
Mortalidad
Biomarcadores
Procalcitonina
Proteína C reactiva
Hemocultivos contaminados

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