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Elevated serum procalcitonin predicts Gram-negative bloodstream infections in patients with burns.
- Source :
-
Burns : journal of the International Society for Burn Injuries [Burns] 2020 Feb; Vol. 46 (1), pp. 182-189. Date of Electronic Publication: 2019 Dec 16. - Publication Year :
- 2020
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Abstract
- Background: Many studies have suggested that procalcitonin can predict bloodstream infection and also distinguish between Gram-negative, Gram-positive and fungal infections after burn. However, up to now, there is no literature on serum procalcitonin level of multidrug-resistant pathogens and non-multidrug-resistant pathogens among Gram-negative bloodstream infections after burn. The purpose of this study is to explore the value of serum procalcitonin in identifying Gram-negative bloodstream infection in patients with febrile critical burn and then to investigate the difference of serum procalcitonin level between multidrug-resistant pathogens and non-multidrug-resistant pathogens among Gram-negative bloodstream infections after burn.<br />Methods: Patients with febrile critical burn admitted to the burn department of our hospital from 1 January 2014 to 1 August 2018 were retrospectively analysed. Patients with positive blood culture whose blood samples were collected for simultaneous blood culture and procalcitonin testing were enrolled. All strains were identified by an automatic microorganism analyser, and procalcitonin was analysed by an automatic electrochemiluminescence immunoassay.<br />Results: Overall, a total of 119 patients with positive blood culture met the inclusion criteria. There were 64 Gram-negative bacilli, 38 Gram-positive bacteria, 8 C. albicans and 9 polymicrobial bloodstream infections. The median procalcitonin value in Gram-negative bloodstream infections (2.67 ng/mL, interquartile range (IQR) 1.58-6.08) was significantly higher than that in Gram-positive bloodstream infections (1.04 ng/mL, IQR 0.35-1.60, P < 0.01), or C. albicans bloodstream infections (1.09 ng/mL, IQR 0.82-2.30, P < 0.05). Receiver operating characteristic curve (ROC) analysis showed that in addition to polymicrobial bloodstream infections, the area of procalcitonin under the curve distinguishing Gram-negative bloodstream infections from all other blood culture-positive bloodstream infections was 0.761, the best critical value was 1.73 ng/mL, the sensitivity was 73%, the specificity was 74%, the positive predictive value was 80%, the negative predictive value was 67%, The level of procalcitonin was significantly higher in multidrug-resistant Gram-negative bacilli (A. baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa) (2.76 ng/mL, IQR 2.01-7.76) than in non-multidrug-resistant bacilli (1.01 ng/mL, IQR 0.58-1.56, P < 0.01).<br />Conclusion: Elevated serum procalcitonin can identify Gram-negative bloodstream infections in patients with febrile critical burn. In Gram-negative bloodstream infections, high procalcitonin levels may be associated with multidrug-resistant Gram-negative bacilli (A. baumannii, K. pneumoniae and P. aeruginosa).<br /> (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Subjects :
- Acinetobacter Infections blood
Acinetobacter Infections complications
Acinetobacter Infections diagnosis
Acinetobacter Infections microbiology
Acinetobacter baumannii physiology
Adult
Bacteremia blood
Bacteremia complications
Bacteremia microbiology
Blood Culture
Burns complications
Candida albicans
Candidemia blood
Candidemia diagnosis
Coinfection blood
Coinfection complications
Coinfection diagnosis
Coinfection microbiology
Drug Resistance, Multiple, Bacterial physiology
Female
Fever etiology
Gram-Negative Bacterial Infections blood
Gram-Negative Bacterial Infections complications
Gram-Negative Bacterial Infections microbiology
Gram-Positive Bacterial Infections blood
Gram-Positive Bacterial Infections complications
Gram-Positive Bacterial Infections microbiology
Humans
Klebsiella Infections blood
Klebsiella Infections complications
Klebsiella Infections diagnosis
Klebsiella Infections microbiology
Klebsiella pneumoniae physiology
Male
Middle Aged
Pseudomonas Infections blood
Pseudomonas Infections complications
Pseudomonas Infections diagnosis
Pseudomonas Infections microbiology
Pseudomonas aeruginosa physiology
Retrospective Studies
Young Adult
Bacteremia diagnosis
Burns blood
Fever blood
Gram-Negative Bacterial Infections diagnosis
Gram-Positive Bacterial Infections diagnosis
Procalcitonin blood
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1409
- Volume :
- 46
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Burns : journal of the International Society for Burn Injuries
- Publication Type :
- Academic Journal
- Accession number :
- 31859083
- Full Text :
- https://doi.org/10.1016/j.burns.2019.04.010