Can high procalcitonin levels be a biomarker for detecting multidrug-resistant Gram-negative bacteremia?

Year 2023, Volume: 6 Issue: 6, 1162 - 1169, 29.10.2023

Şölen Daldaban Dinçer , Ülkü Oral , Meltem Ayaş , Sebahat Aksaray

https://doi.org/10.32322/jhsm.1351860

Abstract

Aims: Clinicians prefer broad-spectrum empirical antibiotic therapy in patients with suspected bloodstream infection (BSI) due to long test turnaround times of conventional methods. We aimed to assess the contribution of procalcitonin (PCT) to the selection of antibiotics to be used in empirical treatment.
Methods: The results of inpatients whose blood cultures and samples for PCT tests had been sent simultaneously between 2018 and 2022 were analyzed retrospectively. Antibiotic susceptibility results of Enterobacteriaceae, Acinetobacter baumannii complex and Pseudomonas aeruginosa, were evaluated for multidrug-resistance (MDR).
Results: Results of 1206 patients who met the inclusion criteria were included in the study. The PCT median value in BSIs caused by the Gram-negative bacteria found to be statistically significantly higher than those caused by the Gram-positive bacteria, fungal and polymicrobial infections (p<0.05). The best cutoff value of ROC, with an AUC value of 0.607 (CI: 95%: 0.578-0.635, p< .0001), a sensitivity of 72.1%, and a specificity of 55.4%, for distinguishing GN BSIs from other BSIs was determined as 2.5 ng/ml. The PCT median value of MDR pathogens was found to be statistically significantly higher than that of non-MDR pathogens (p < 0.05). A ROC analysis was performed, and the AUC distinguishing MDR pathogens from non-MDR was found as 0.633(CI: 95%, 0.586-0.681; p <0.0001), with a best PCT cutoff of 11.4 ng/mL, a sensitivity of 54.8%, and a specificity of 66.3%
Conclusion: High levels of PCT can guide empirical antibiotic treatments, with its property to predict GN bacteria and that they might be MDR GN BSIs.

Keywords

Procalcitonin, bloodstream infection, Gram negative bacteriae, multidrug resistance

Supporting Institution

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