Research Article
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Year 2025, Volume: 15 Issue: 2, 153 - 159, 29.08.2025
https://doi.org/10.26650/experimed.1558405

Abstract

Project Number

--

References

  • 1. Smith DA, Nehring SM. Bacteremia. İn: StatPearls [İnternet]. Treasure İsland (FL): StatPearls Publishing; 2023 Jan. (PMİD: 28723008). Available from: https:// www.ncbi.nlm.nih.gov/books/NBK441979/ Accessed November 13, 2022. google scholar
  • 2. Hoeboer SH, van der Geest PJ, Nieboer D, Groeneveld AB. THe diagnostic accuracy of procalcitonin for bacteraemia: a systematic review and meta-analysis. Clin Microbiol İnfect 2015; 21(5): 474-81. google scholar
  • 3. Peters RP, van Agtmael MA, Danner SA, Savelkoul PH, Vandenbroucke-Grauls CM. New developments in tHe diagnosis of bloodstream infections. Lancet İnfect Dis 2004; 4(12): 751-60. google scholar
  • 4. Markanday A. Acute pHase reactants in infections: Evidence-based review and a guide for clinicians. Open Forum İnfect Dis 2015; 2(3): ofv098. google scholar
  • 5. NisHikawa H, SHirano M, Kasamatsu Y, Morimura A, İida K, KisHi T, et al. Comparative usefulness of inflammatory markers to indicate bacterial infection-analyzed according to blood culture results and related clinical factors. Diagn Microbiol İnfect Dis 2016; 84(1): 69-73. google scholar
  • 6. Guo SY, ZHou Y, Hu QF, Yao J, Wang H. Procalcitonin is a marker of gram-negative bacteremia in patients witH sepsis. Am J Med Sci 2015; 349(6): 499-504. google scholar
  • 7. THomas-Rüddel DO, Poidinger B, Kott M, Weiss M, ReinHart K, Bloos F. MEDUSA study group. İnfluence of patHogen and focus of infection on procalcitonin values in sepsis patients witH bacteremia or candidemia. Crit Care 2018; 22(1): 128. google scholar
  • 8. El-Azeem AA, Hamdy G, Saraya M, Fawzy E, Anwar E, Abdulattif S. THe role of procalcitonin as a guide for tHe diagnosis, prognosis, and decision of antibiotic tHerapy for lower respiratory tract infections. Egypt J CHest Dis Tuberc 2013; 62(4): 687-95. google scholar
  • 9. AabenHus R, Jensen JU. Procalcitonin-guided antibiotic treatment of respiratory tract infections in a primary care setting: are we tHere yet? Prim Care Respir J 2011; 20(4): 360-7. google scholar
  • 10. BrecHot N, Hekimian G, CHastre J, Luyt CE. Procalcitonin to gülde antlblotlc tHerapy in tHe İCU. İnt J Antimicrob Agents 2015; 46 Suppl 1: S19-24. google scholar
  • 11. Jin M, KHan Aİ. Procalcitonin: uses in tHe clinical laboratory for tHe diagnosis of sepsis. Lab Med 2010; 41(3): 173-7. google scholar
  • 12. Tokars Jİ. Predictive value of blood cultures positive for coagulase-negative stapHylococci: implications for patient care and HealtH care quality assurance. Clin İnfect Dis 2004; 39(3): 333-41. google scholar
  • 13. Hall KK, Lyman JA. Update review of blood culture contamination. Clin Microb Rev 2006; 19: 788-802. google scholar
  • 14. Clinical and Laboratory Standarts İnstitute. Principles and procedures for blood cultures. Approved Guideline. M47-A, Vol. 27 No. 17. Clinical and Laboratory Standards İnstitute; 2007. Wayne, PA. google scholar
  • 15. ScHuetz P, Mueller B, Trampuz A. Serum procalcitonin for discrimination of blood contamination from bloodstream infection due to coagulase-negative stapHylococci. İnfection 2007; 35(5): 352-5. google scholar
  • 16. Oksuz L, Somer A, Salman N, Erk O, Gurler N. Procalcitonin and C-reactive protein in differantiating to contamination from bacteremia. Braz J Microbiol 2015; 45(4): 1415-21. google scholar
  • 17. Zafar lqbal-Mirza S, Serrano Romero de Âvila V, Estevez-Gonzâlez R, Rodrıguez-Gonzâlez D, Heredero-Gâlvez E, Juliân-Jimenez A. Ability of procalcitonin to differentiate true bacteraemia from contaminated blood cultures in an emergency department. Enferm İnfecc Microbiol Clin (Engl Ed) 2019; 37(9): 560-8. google scholar
  • 18. Jeong S, Park Y, CHo Y, Kim HS. Diagnostic utilities of procalcitonin and C-reactive protein for tHe prediction of bacteremia determined by blood culture. Clin CHim Acta 2012; 413(21-22): 1731-6. google scholar
  • 19. BertHezene C, Alssa N, Manteaux AE, Gueant JL, OussalaH A, Lozniewski A. Accuracy of procalcitonin for diagnosing peripHeral blood culture contamination among patients witH positive blood culture for potential contaminants. İnfection 2021; 49(6): 1249-55. google scholar
  • 20. Kim MH, Lim G, Kang SY, Lee Wİ, SuH JT, Lee HJ. Utility of procalcitonin as an early diagnostic marker of bacteremia in patients witH acute fever. Yonsei Med J 2011; 52: 276-81. google scholar
  • 21. Engel A, Steinbach G, Kern P, Kern WV. Diagnostic value of procalcitonin serum levels in neutropenic patients with fever: comparison with interleukin-8. Scand J Infect Dis 1999; 31: 185-9. google scholar
  • 22. Svaldi M, Hirber J, Lanthaler AI, Mayr O, Faes S, Peer E, et al. Procalcitonin-reduced sensitivity and specificity in heavily leucopenic and immunosuppressed patients. Br J Haematol 2001; 115(1): 53-7. google scholar
  • 23. Leli C, Ferranti M, Moretti A, Al Dhahab ZS, Cenci E, Mencacci A. Procalcitonin levels in gram-positive, gram-negative, and fungal bloodstream infections. Dis Markers 2015; 2015: 701480. google scholar
  • 24. Yan ST, Sun LC, Jia HB, Gao W, Yang JP, Zhang GQ. Procalcitonin levels in bloodstream infections caused by different sources and species of bacteria. Am J Emerg Med 2017; 35(4): 579-83. google scholar
  • 25. Ogasawara S, Saito N, Hirano R, Minakawa S, Kimura M, Kayaba H. Clinical relevance of procalcitonin values in bacteremia. J Infect Chemother 2020; 26(10): 1048-53. google scholar
  • 26. Dinçer ŞD, Zeyinli ÜO, Ayaş M, Aksaray S. Can high procalcitonin levels be a biomarker for detecting multidrug-resistant Gram-negative bacteremia? J Health Sci Med 2023; 6(6): 1162-9. google scholar
  • 27. Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med 2011; 9: 107. google scholar
  • 28. Paudel R, Dogra P, Montgomery-Yates AA, Coz Yataco A. Procalcitonin: A promising tool or just another overhyped test? Int J Med Sci 2020; 17(3): 332-7. google scholar
  • 29. Jankovic R, Stojanovic M, Bozov H, Domi R, Ivancan V, Karisik M et al. Procalcitonin guided antibiotic stewardship: A Balkan expert consensus statement. Acta Clin Croat 2023; 62: 36-44. google scholar

Accuracy of Procalcitonin in the Diagnosis of Bacteremia and Discrimination from Contamination

Year 2025, Volume: 15 Issue: 2, 153 - 159, 29.08.2025
https://doi.org/10.26650/experimed.1558405

Abstract

Objective: In this study, we aimed to evaluate the concordance of blood culture with procalcitonin (PCT) alone and together with C-reactive protein (CRP) in detecting bacteremia and the diagnostic performance of these biomarkers to differentiate contamination from true bacteremia.

Materials and Methods: The medical records of 310 patients were analysed retrospectively. Advia Centaur XP immunoassay system and Au analysers were used to determine PCT and CRP levels, respectively. BacT/ Alert 3D60 hemoculture system was used to incubate blood specimens, and VITEK 2 compact was used to identify isolated strains.

Results: The accuracy of PCT and CRP in detecting bacteremia were found to be 68.1% and 36.4%, respectively, and combining PCT and CRP had no added value. In analysis of receiver operating characteristic (ROC), the area under the ROC curve (AUROC) values of PCT and CRP were found to be 0.889 and 0.779 in discriminating the culture-negative group from the culture-positive group, and 0.645 and 0.502 in discriminating bacteremia from contamination, respectively.

Conclusion: PCT is a reliable marker that can be used to detect bacteremia. However, its discriminative power was low in differentiating true bacteremia from contamination. Therefore, PCT levels alone should not be used to rule out blood culture contamination.

Ethical Statement

This study was reviewed and approved by Kocaeli University Ethical Committee of Non-Invasive Clinical Research (Approval no: GOKAEK-2017/4.09) and the ethical standards of the Declaration of Helsinki was followed.

Supporting Institution

None to declare

Project Number

--

Thanks

The authors would like to thank everyone who contributed to the study.

References

  • 1. Smith DA, Nehring SM. Bacteremia. İn: StatPearls [İnternet]. Treasure İsland (FL): StatPearls Publishing; 2023 Jan. (PMİD: 28723008). Available from: https:// www.ncbi.nlm.nih.gov/books/NBK441979/ Accessed November 13, 2022. google scholar
  • 2. Hoeboer SH, van der Geest PJ, Nieboer D, Groeneveld AB. THe diagnostic accuracy of procalcitonin for bacteraemia: a systematic review and meta-analysis. Clin Microbiol İnfect 2015; 21(5): 474-81. google scholar
  • 3. Peters RP, van Agtmael MA, Danner SA, Savelkoul PH, Vandenbroucke-Grauls CM. New developments in tHe diagnosis of bloodstream infections. Lancet İnfect Dis 2004; 4(12): 751-60. google scholar
  • 4. Markanday A. Acute pHase reactants in infections: Evidence-based review and a guide for clinicians. Open Forum İnfect Dis 2015; 2(3): ofv098. google scholar
  • 5. NisHikawa H, SHirano M, Kasamatsu Y, Morimura A, İida K, KisHi T, et al. Comparative usefulness of inflammatory markers to indicate bacterial infection-analyzed according to blood culture results and related clinical factors. Diagn Microbiol İnfect Dis 2016; 84(1): 69-73. google scholar
  • 6. Guo SY, ZHou Y, Hu QF, Yao J, Wang H. Procalcitonin is a marker of gram-negative bacteremia in patients witH sepsis. Am J Med Sci 2015; 349(6): 499-504. google scholar
  • 7. THomas-Rüddel DO, Poidinger B, Kott M, Weiss M, ReinHart K, Bloos F. MEDUSA study group. İnfluence of patHogen and focus of infection on procalcitonin values in sepsis patients witH bacteremia or candidemia. Crit Care 2018; 22(1): 128. google scholar
  • 8. El-Azeem AA, Hamdy G, Saraya M, Fawzy E, Anwar E, Abdulattif S. THe role of procalcitonin as a guide for tHe diagnosis, prognosis, and decision of antibiotic tHerapy for lower respiratory tract infections. Egypt J CHest Dis Tuberc 2013; 62(4): 687-95. google scholar
  • 9. AabenHus R, Jensen JU. Procalcitonin-guided antibiotic treatment of respiratory tract infections in a primary care setting: are we tHere yet? Prim Care Respir J 2011; 20(4): 360-7. google scholar
  • 10. BrecHot N, Hekimian G, CHastre J, Luyt CE. Procalcitonin to gülde antlblotlc tHerapy in tHe İCU. İnt J Antimicrob Agents 2015; 46 Suppl 1: S19-24. google scholar
  • 11. Jin M, KHan Aİ. Procalcitonin: uses in tHe clinical laboratory for tHe diagnosis of sepsis. Lab Med 2010; 41(3): 173-7. google scholar
  • 12. Tokars Jİ. Predictive value of blood cultures positive for coagulase-negative stapHylococci: implications for patient care and HealtH care quality assurance. Clin İnfect Dis 2004; 39(3): 333-41. google scholar
  • 13. Hall KK, Lyman JA. Update review of blood culture contamination. Clin Microb Rev 2006; 19: 788-802. google scholar
  • 14. Clinical and Laboratory Standarts İnstitute. Principles and procedures for blood cultures. Approved Guideline. M47-A, Vol. 27 No. 17. Clinical and Laboratory Standards İnstitute; 2007. Wayne, PA. google scholar
  • 15. ScHuetz P, Mueller B, Trampuz A. Serum procalcitonin for discrimination of blood contamination from bloodstream infection due to coagulase-negative stapHylococci. İnfection 2007; 35(5): 352-5. google scholar
  • 16. Oksuz L, Somer A, Salman N, Erk O, Gurler N. Procalcitonin and C-reactive protein in differantiating to contamination from bacteremia. Braz J Microbiol 2015; 45(4): 1415-21. google scholar
  • 17. Zafar lqbal-Mirza S, Serrano Romero de Âvila V, Estevez-Gonzâlez R, Rodrıguez-Gonzâlez D, Heredero-Gâlvez E, Juliân-Jimenez A. Ability of procalcitonin to differentiate true bacteraemia from contaminated blood cultures in an emergency department. Enferm İnfecc Microbiol Clin (Engl Ed) 2019; 37(9): 560-8. google scholar
  • 18. Jeong S, Park Y, CHo Y, Kim HS. Diagnostic utilities of procalcitonin and C-reactive protein for tHe prediction of bacteremia determined by blood culture. Clin CHim Acta 2012; 413(21-22): 1731-6. google scholar
  • 19. BertHezene C, Alssa N, Manteaux AE, Gueant JL, OussalaH A, Lozniewski A. Accuracy of procalcitonin for diagnosing peripHeral blood culture contamination among patients witH positive blood culture for potential contaminants. İnfection 2021; 49(6): 1249-55. google scholar
  • 20. Kim MH, Lim G, Kang SY, Lee Wİ, SuH JT, Lee HJ. Utility of procalcitonin as an early diagnostic marker of bacteremia in patients witH acute fever. Yonsei Med J 2011; 52: 276-81. google scholar
  • 21. Engel A, Steinbach G, Kern P, Kern WV. Diagnostic value of procalcitonin serum levels in neutropenic patients with fever: comparison with interleukin-8. Scand J Infect Dis 1999; 31: 185-9. google scholar
  • 22. Svaldi M, Hirber J, Lanthaler AI, Mayr O, Faes S, Peer E, et al. Procalcitonin-reduced sensitivity and specificity in heavily leucopenic and immunosuppressed patients. Br J Haematol 2001; 115(1): 53-7. google scholar
  • 23. Leli C, Ferranti M, Moretti A, Al Dhahab ZS, Cenci E, Mencacci A. Procalcitonin levels in gram-positive, gram-negative, and fungal bloodstream infections. Dis Markers 2015; 2015: 701480. google scholar
  • 24. Yan ST, Sun LC, Jia HB, Gao W, Yang JP, Zhang GQ. Procalcitonin levels in bloodstream infections caused by different sources and species of bacteria. Am J Emerg Med 2017; 35(4): 579-83. google scholar
  • 25. Ogasawara S, Saito N, Hirano R, Minakawa S, Kimura M, Kayaba H. Clinical relevance of procalcitonin values in bacteremia. J Infect Chemother 2020; 26(10): 1048-53. google scholar
  • 26. Dinçer ŞD, Zeyinli ÜO, Ayaş M, Aksaray S. Can high procalcitonin levels be a biomarker for detecting multidrug-resistant Gram-negative bacteremia? J Health Sci Med 2023; 6(6): 1162-9. google scholar
  • 27. Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med 2011; 9: 107. google scholar
  • 28. Paudel R, Dogra P, Montgomery-Yates AA, Coz Yataco A. Procalcitonin: A promising tool or just another overhyped test? Int J Med Sci 2020; 17(3): 332-7. google scholar
  • 29. Jankovic R, Stojanovic M, Bozov H, Domi R, Ivancan V, Karisik M et al. Procalcitonin guided antibiotic stewardship: A Balkan expert consensus statement. Acta Clin Croat 2023; 62: 36-44. google scholar
There are 29 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section Research Article
Authors

Nüket Hayırlıoğlu 0000-0003-1975-4884

Ayşe Demet Kaya 0000-0001-8224-8242

Deniz Sertel Selale 0000-0001-8437-3557

Mine Aydın Kurç 0000-0002-5053-4276

Gamze Varol 0000-0002-3490-3406

Project Number --
Publication Date August 29, 2025
Submission Date October 1, 2024
Acceptance Date June 10, 2025
Published in Issue Year 2025 Volume: 15 Issue: 2

Cite

Vancouver Hayırlıoğlu N, Kaya AD, Sertel Selale D, Aydın Kurç M, Varol G. Accuracy of Procalcitonin in the Diagnosis of Bacteremia and Discrimination from Contamination. Experimed. 2025;15(2):153-9.