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RESEARCH PRODUCT

Procalcitonin levels in candidemia versus bacteremia: a systematic review

Ignacio Martin-loechesMatteo BassettiAntonino GiarratanoAndrea CortegianiGiovanni MisseriMariachiara IppolitoSharon Einav

subject

AdultMaleCalcitoninmedicine.medical_specialtyLetterBacteremiaCritical Care and Intensive Care MedicineProcalcitoninlaw.inventionSepsis03 medical and health sciences0302 clinical medicineBiomarker; Candida; Candidemia; Fungal; Fungi; PCT; Procalcitonin; SepsislawSecondary analysisSepsisparasitic diseasesmedicineHumansIntensive care medicineCandidaAdult patientsbusiness.industryResearchlcsh:Medical emergencies. Critical care. Intensive care. First aidFungiCandidemia030208 emergency & critical care medicinelcsh:RC86-88.9Biomarkermedicine.diseasebacterial infections and mycosesIntensive care unitFungalBacteremiaBiomarker (medicine)FemaleDifferential diagnosisbusinessPCTProcalcitoninhormones hormone substitutes and hormone antagonistsBiomarkers

description

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 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 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 PCT should not be used as a standalone tool for the differential diagnosis between candidemia and bacteremia due to limited supporting evidence. Electronic supplementary material The online version of this article (10.1186/s13054-019-2481-y) contains supplementary material, which is available to authorized users.

yearjournalcountryeditionlanguage
2019-05-01Critical Care
10.1186/s13054-019-2481-yhttp://europepmc.org/articles/PMC6537202