Email updates

Keep up to date with the latest news and content from BMC Infectious Diseases and BioMed Central.

Open Access Highly Accessed Research article

Serum procalcitonin for the early recognition of nosocomial infection in the critically ill patients: a preliminary report

Pierre Emmanuel Charles1*, Emmanuel Kus1, Serge AHO2, Sébastien Prin1, Jean-Marc Doise1, Nils-Olivier Olsson3, Bernard Blettery1 and Jean-Pierre Quenot1

Author Affiliations

1 Service de Réanimation Médicale, Hôpital Le Bocage, CHU de DIJON, France

2 Service d'Epidémiologie et d'Hygiène Hospitalière, Hôpital Le Bocage, CHU de DIJON, France

3 Laboratoire d'Immunologie, Hôpital Le Bocage, CHU de DIJON, France

For all author emails, please log on.

BMC Infectious Diseases 2009, 9:49  doi:10.1186/1471-2334-9-49

Published: 22 April 2009

Abstract

Background

The usefulness of procalcitonin (PCT) measurement in critically ill medical patients with suspected nosocomial infection is unclear. The aim of the study was to assess PCT value for the early diagnosis of bacterial nosocomial infection in selected critically ill patients.

Methods

An observational cohort study in a 15-bed intensive care unit was performed. Seventy patients with either proven (n = 47) or clinically suspected but not confirmed (n = 23) nosocomial infection were included. Procalcitonin measurements were obtained the day when the infection was suspected (D0) and at least one time within the 3 previous days (D-3 to D0). Patients with proven infection were compared to those without. The diagnostic value of PCT on D0 was determined through the construction of the corresponding receiver operating characteristic (ROC) curve. In addition, the predictive value of PCT variations preceding the clinical suspicion of infection was assessed.

Results

PCT on D0 was the best predictor of proven infection in this population of ICU patients with a clinical suspicion of infection (AUROCC = 0.80; 95% CI, 0.68–0.91). Thus, a cut-off value of 0.44 ng/mL provides sensitivity and specificity of 65.2% and 83.0%, respectively. Procalcitonin variation between D-1 and D0 was calculated in 45 patients and was also found to be predictive of nosocomial infection (AUROCC = 0.89; 95% CI, 0.79–0.98) with a 100% positive predictive value if the +0.26 ng/mL threshold value was applied. Comparable results were obtained when PCT variation between D-2 and D0, or D-3 and D0 were considered. In contrast, CRP elevation, leukocyte count and fever had a poor predictive value in our population.

Conclusion

PCT monitoring could be helpful in the early diagnosis of nosocomial infection in the ICU. Both absolute values and variations should be considered and evaluated in further studies.