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      Procalcitonin levels in candidemia versus bacteremia: a systematic review

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          Abstract

          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.

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          Most cited references34

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          Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors.

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            Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris

            Candida spp. infections are a major cause of morbidity and mortality in critically ill patients. Candida auris is an emerging multi-drug-resistant fungus that is rapidly spreading worldwide. Since the first reports in 2009, many isolates across five continents have been identified as agents of hospital-associated infections. Independent and simultaneous outbreaks of C. auris are becoming a major concern for healthcare and scientific community. Moreover, laboratory misidentification and multi-drug-resistant profiles, rarely observed for other non-albicans Candida species, result in difficult eradication and frequent therapeutic failures of C. auris infections. The aim of this review was to provide an updated and comprehensive report of the global spread of C. auris, focusing on clinical and microbiological characteristics, mechanisms of virulence and antifungal resistance, and efficacy of available control, preventive, and therapeutic strategies. Electronic supplementary material The online version of this article (10.1186/s40560-018-0342-4) contains supplementary material, which is available to authorized users.
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              Procalcitonin-guided diagnosis and antibiotic stewardship revisited

              Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i.e., pneumonia). In these indications, PCT levels measured on hospital admission were found to substantially reduce the initiation of antibiotic treatment in low-risk situations (i.e., bronchitis, chronic obstructive pulmonary disease exacerbation). For more severe infections (i.e., pneumonia, sepsis), antibiotic stewardship by monitoring of PCT kinetics resulted in shorter antibiotic treatment durations with early cessation of therapy. Importantly, these strategies appear to be safe without increasing the risk for mortality, recurrent infections, or treatment failures. PCT kinetics also proved to have prognostic value correlating with disease severity (i.e., pancreatitis, abdominal infection) and resolution of illness (i.e., sepsis). Although promising findings have been published in these different types of infections, there are a number of limitations regarding PCT, including suboptimal sensitivity and/or specificity, which makes a careful interpretation of PCT in the clinical context mandatory. This narrative review aims to update clinicians on the strengths and limitations of PCT for patient management, focusing on research conducted within the last 4 years.
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                Author and article information

                Contributors
                +390916552718 , cortegiania@gmail.com , andrea.cortegiani@unipa.it
                giovannimisseri1987@gmail.com
                ippolito.mariachiara@gmail.com
                matteo.bassetti@asuiud.sanita.fvg.it
                antonino.giarratano@unipa.it
                drmartinloeches@gmail.com
                einav_s@szmc.org.il
                Journal
                Crit Care
                Critical Care
                BioMed Central (London )
                1364-8535
                1466-609X
                28 May 2019
                28 May 2019
                2019
                : 23
                : 190
                Affiliations
                [1 ]ISNI 0000 0004 1762 5517, GRID grid.10776.37, Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.). Section of Anesthesia, Analgesia, Intensive Care and Emergency, , Policlinico Paolo Giaccone, University of Palermo, ; via del vespro 129, 90127 Palermo, Italy
                [2 ]GRID grid.411492.b, Infectious Diseases Division, Department of Medicine, , University of Udine and Santa Maria della Misericordia University Hospital, ; Piazzale Santa Maria della Misericordia 15, Udine, Italy
                [3 ]ISNI 0000 0004 0617 8280, GRID grid.416409.e, Multidisciplinary Intensive Care Research Organization (MICRO), , St. James’s Hospital, ; Dublin, Ireland
                [4 ]ISNI 0000 0004 1937 0247, GRID grid.5841.8, Hospital Clinic, , Universidad de Barcelona, CIBERes, ; Barcelona, Spain
                [5 ]ISNI 0000 0004 1937 0538, GRID grid.9619.7, Intensive Care Unit of the Shaare Zedek Medical Medical Centre and Hebrew University Faculty of Medicine, ; Jerusalem, Israel
                Author information
                http://orcid.org/0000-0003-1416-9993
                Article
                2481
                10.1186/s13054-019-2481-y
                6537202
                31138262
                f51126bb-9544-4fda-8ad5-74f29f251e64
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 March 2019
                : 19 May 2019
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Emergency medicine & Trauma
                procalcitonin,pct,sepsis,candida,fungi,candidemia,biomarker,fungal
                Emergency medicine & Trauma
                procalcitonin, pct, sepsis, candida, fungi, candidemia, biomarker, fungal

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