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Chest Infections |

False Negative Procalcitonin Levels in Patients With Positive Blood Cultures

Vinod Jona, MD; Ramesh Bharadwaj, MD; Jenna Swindler*, PharmD; Cathy Stokes, MSN
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McLeod Regional Medical Center, Florence, SC


Chest. 2012;142(4_MeetingAbstracts):230A. doi:10.1378/chest.1388314
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Abstract

SESSION TYPE: ICU Infections

PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM

PURPOSE: Procalcitonin (PCT), a peptide precursor of calcitonin, is released in response to pro-inflammatory stimuli. PCT is released in the bloodstream 2-6 hours after bacteria or bacterial products are present in the blood. PCT levels <0.5 ng/mL can potentially rule out severe sepsis or septic shock, but may not exclude localized infections. PCT levels > 2 ng/mL are highly suggestive of an infectious process. There is data regarding both elevations of PCT in the absence of bacterial infections (false positives) and normal PCT levels in the presence of documented infections (false negatives). The purpose of this review was to evaluate patients with a single PCT level and documented positive blood cultures.

METHODS: This was a retrospective chart review of all patients from February 2011 to February 2012 with 2 sets of positive blood cultures and a single PCT level done 2 days before cultures, the day of cultures, or 2 days after cultures. To be included the patient must have had the same pathogen in both sets of blood cultures. A negative PCT level was defined as less than 2 ng/mL and a positive PCT level was defined as greater than or equal to 2 ng/mL.

RESULTS: A total of 75 patients were reviewed during this study. 15 out of 75 patients (20%) had a PCT level < 2 ng/mL with positive blood cultures. PCT levels were performed the same day as blood cultures in 13 patients and the day after blood cultures in 2 patients. 53 % of patients in this group had a gram positive bloodstream infection, most commonly due to staphylococcus aureus.

CONCLUSIONS: A single PCT level of < 2 ng/mL may not rule out bacteremia, especially secondary to staphylococcus aureus. Other pertinent patient specific data should be evaluated when making decisions regarding antimicrobial therapy.

CLINICAL IMPLICATIONS: Repeat PCT levels, microbiological data, and the patient's clinical condition should be utilized to guide antimicrobial therapy.

DISCLOSURE: The following authors have nothing to disclose: Vinod Jona, Ramesh Bharadwaj, Jenna Swindler, Cathy Stokes

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McLeod Regional Medical Center, Florence, SC

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