Can procalcitonin help identify associated bacterial infection in patients with severe influenza pneumonia? A multicentre study
Identifieur interne : 000921 ( Pmc/Checkpoint ); précédent : 000920; suivant : 000922Can procalcitonin help identify associated bacterial infection in patients with severe influenza pneumonia? A multicentre study
Auteurs : E. Cuquemelle [France] ; F. Soulis [France] ; D. Villers [France] ; F. Roche-Campo [Espagne] ; C. Ara Somohano [France] ; M. Fartoukh [France] ; A. Kouatchet [France] ; B. Mourvillier [France] ; J. Dellamonica [France] ; W. Picard [France] ; M. Schmidt [France] ; T. Boulain [France] ; C. Brun-Buisson [France]Source :
- Intensive Care Medicine [ 0342-4642 ] ; 2011.
Abstract
To determine whether procalcitonin (PCT) levels could help discriminate isolated viral from mixed (bacterial and viral) pneumonia in patients admitted to the intensive care unit (ICU) during the A/H1N1v2009 influenza pandemic.
A retrospective observational study was performed in 23 French ICUs during the 2009 H1N1 pandemic. Levels of PCT at admission were compared between patients with confirmed influenzae A pneumonia associated or not associated with a bacterial co-infection.
Of 103 patients with confirmed A/H1N1 infection and not having received prior antibiotics, 48 (46.6%; 95% CI 37–56%) had a documented bacterial co-infection, mostly caused by
PCT may help discriminate viral from mixed pneumonia during the influenza season. Levels of PCT less than 0.8 μg/l combined with clinical judgment suggest that bacterial infection is unlikely.
Url:
DOI: 10.1007/s00134-011-2189-1
PubMed: 21369807
PubMed Central: 7080069
Affiliations:
- Espagne, France
- Aquitaine, Auvergne-Rhône-Alpes, Haute-Normandie, Nouvelle-Aquitaine, Provence-Alpes-Côte d'Azur, Rhône-Alpes, Région Normandie
- Grenoble, Nice, Pau, Rouen
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A multicentre study</title><author><name sortKey="Cuquemelle, E" sort="Cuquemelle, E" uniqKey="Cuquemelle E" first="E." last="Cuquemelle">E. Cuquemelle</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.410511.0</institution-id><institution-id institution-id-type="ISNI">0000000121497878</institution-id><institution>Service de Réanimation médicale, Medical Intensive Care Unit, GH Henri Mondor, AP-HP,</institution><institution>Université Paris-Est Créteil,</institution></institution-wrap>Créteil, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Créteil</wicri:regionArea></affiliation></author><author><name sortKey="Soulis, F" sort="Soulis, F" uniqKey="Soulis F" first="F." last="Soulis">F. Soulis</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Medical Intensive Care Unit, Centre Hospitalo-Universitaire Charles Nicolle, Rouen, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Medical Intensive Care Unit, Centre Hospitalo-Universitaire Charles Nicolle, Rouen</wicri:regionArea><placeName><region type="region">Région Normandie</region><region type="old region">Haute-Normandie</region><settlement type="city">Rouen</settlement></placeName></affiliation></author><author><name sortKey="Villers, D" sort="Villers, D" uniqKey="Villers D" first="D." last="Villers">D. 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Michallon, Grenoble</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Grenoble</settlement></placeName></affiliation></author><author><name sortKey="Fartoukh, M" sort="Fartoukh, M" uniqKey="Fartoukh M" first="M." last="Fartoukh">M. Fartoukh</name><affiliation wicri:level="1"><nlm:aff id="Aff6"><institution-wrap><institution-id institution-id-type="GRID">grid.50550.35</institution-id><institution-id institution-id-type="ISNI">0000000121754109</institution-id><institution>Medical Intensive Care Unit,</institution><institution>APHP, Centre Hospitalo-Universitaire Tenon, AP-HP,</institution></institution-wrap>Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paris</wicri:regionArea></affiliation></author><author><name sortKey="Kouatchet, A" sort="Kouatchet, A" uniqKey="Kouatchet A" first="A." last="Kouatchet">A. 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Mourvillier</name><affiliation wicri:level="1"><nlm:aff id="Aff8"><institution-wrap><institution-id institution-id-type="GRID">grid.50550.35</institution-id><institution-id institution-id-type="ISNI">0000000121754109</institution-id><institution>Medical Intensive Care Unit,</institution><institution>APHP, Centre Hospitalo-Universitaire Bichat-Claude Bernard, AP-HP,</institution></institution-wrap>Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paris</wicri:regionArea></affiliation></author><author><name sortKey="Dellamonica, J" sort="Dellamonica, J" uniqKey="Dellamonica J" first="J." last="Dellamonica">J. Dellamonica</name><affiliation wicri:level="3"><nlm:aff id="Aff9">Medical Intensive Care Unit, Centre Hospitalo-Universitaire Archet 1, Nice, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Medical Intensive Care Unit, Centre Hospitalo-Universitaire Archet 1, Nice</wicri:regionArea><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Nice</settlement></placeName></affiliation></author><author><name sortKey="Picard, W" sort="Picard, W" uniqKey="Picard W" first="W." last="Picard">W. Picard</name><affiliation wicri:level="3"><nlm:aff id="Aff10">Polyvalent Intensive Care Unit, Centre Hospitalier F. Mitterand, Pau, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Polyvalent Intensive Care Unit, Centre Hospitalier F. Mitterand, Pau</wicri:regionArea><placeName><region type="region">Nouvelle-Aquitaine</region><region type="old region">Aquitaine</region><settlement type="city">Pau</settlement></placeName></affiliation></author><author><name sortKey="Schmidt, M" sort="Schmidt, M" uniqKey="Schmidt M" first="M." last="Schmidt">M. Schmidt</name><affiliation wicri:level="1"><nlm:aff id="Aff11"><institution-wrap><institution-id institution-id-type="GRID">grid.411439.a</institution-id><institution-id institution-id-type="ISNI">0000000121509058</institution-id><institution>Medical Intensive Care Unit,</institution><institution>APHP, Centre Hospitalo-Universitaire Pitié-Salpétrière, Paris, AP-HP,</institution></institution-wrap>Paris, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Paris</wicri:regionArea></affiliation></author><author><name sortKey="Boulain, T" sort="Boulain, T" uniqKey="Boulain T" first="T." last="Boulain">T. Boulain</name><affiliation wicri:level="1"><nlm:aff id="Aff12"><institution-wrap><institution-id institution-id-type="GRID">grid.413932.e</institution-id><institution-id institution-id-type="ISNI">0000 0004 1792 201X</institution-id><institution>Medical ICU,</institution><institution>Centre Hospitalier Régional,</institution></institution-wrap>Orléans, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Orléans</wicri:regionArea></affiliation></author><author><name sortKey="Brun Buisson, C" sort="Brun Buisson, C" uniqKey="Brun Buisson C" first="C." last="Brun-Buisson">C. Brun-Buisson</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.410511.0</institution-id><institution-id institution-id-type="ISNI">0000000121497878</institution-id><institution>Service de Réanimation médicale, Medical Intensive Care Unit, GH Henri Mondor, AP-HP,</institution><institution>Université Paris-Est Créteil,</institution></institution-wrap>Créteil, France</nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Créteil</wicri:regionArea></affiliation></author></analytic><series><title level="j">Intensive Care Medicine</title><idno type="ISSN">0342-4642</idno><idno type="eISSN">1432-1238</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>To determine whether procalcitonin (PCT) levels could help discriminate isolated viral from mixed (bacterial and viral) pneumonia in patients admitted to the intensive care unit (ICU) during the A/H1N1v2009 influenza pandemic.</p></sec><sec><title>Methods</title><p>A retrospective observational study was performed in 23 French ICUs during the 2009 H1N1 pandemic. Levels of PCT at admission were compared between patients with confirmed influenzae A pneumonia associated or not associated with a bacterial co-infection.</p></sec><sec><title>Results</title><p>Of 103 patients with confirmed A/H1N1 infection and not having received prior antibiotics, 48 (46.6%; 95% CI 37–56%) had a documented bacterial co-infection, mostly caused by <italic>Streptococcus pneumoniae</italic> (54%) or <italic>Staphylococcus aureus</italic> (31%). Fifty-two patients had PCT measured on admission, including 19 (37%) having bacterial co-infection. Median (range 25–75%) values of PCT were significantly higher in patients with bacterial co-infection: 29.5 (3.9–45.3) versus 0.5 (0.12–2) μg/l (<italic>P</italic> < 0.01). For a cut-off of 0.8 μg/l or more, the sensitivity and specificity of PCT for distinguishing isolated viral from mixed pneumonia were 91 and 68%, respectively. Alveolar condensation combined with a PCT level of 0.8 μg/l or more was strongly associated with bacterial co-infection (OR 12.9, 95% CI 3.2–51.5; <italic>P</italic> < 0.001).</p></sec><sec><title>Conclusions</title><p>PCT may help discriminate viral from mixed pneumonia during the influenza season. Levels of PCT less than 0.8 μg/l combined with clinical judgment suggest that bacterial infection is unlikely.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Jain, S" uniqKey="Jain S">S Jain</name></author><author><name sortKey="Kamimoto, L" uniqKey="Kamimoto L">L Kamimoto</name></author><author><name sortKey="Bramley, Am" uniqKey="Bramley A">AM Bramley</name></author><author><name sortKey="Schmitz, Am" uniqKey="Schmitz A">AM Schmitz</name></author><author><name sortKey="Benoit, Sr" uniqKey="Benoit S">SR Benoit</name></author><author><name sortKey="Louie, J" uniqKey="Louie J">J Louie</name></author><author><name sortKey="Sugerman, De" uniqKey="Sugerman D">DE Sugerman</name></author><author><name sortKey="Druckenmiller, Jk" uniqKey="Druckenmiller J">JK Druckenmiller</name></author><author><name sortKey="Ritger, Ka" uniqKey="Ritger K">KA Ritger</name></author><author><name sortKey="Chugh, R" uniqKey="Chugh R">R 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Intensive Care Med</journal-id><journal-id journal-id-type="iso-abbrev">Intensive Care Med</journal-id><journal-title-group><journal-title>Intensive Care Medicine</journal-title></journal-title-group><issn pub-type="ppub">0342-4642</issn><issn pub-type="epub">1432-1238</issn><publisher><publisher-name>Springer-Verlag</publisher-name><publisher-loc>Berlin/Heidelberg</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21369807</article-id><article-id pub-id-type="pmc">7080069</article-id><article-id pub-id-type="publisher-id">2189</article-id><article-id pub-id-type="doi">10.1007/s00134-011-2189-1</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original</subject></subj-group></article-categories><title-group><article-title>Can procalcitonin help identify associated bacterial infection in patients with severe influenza pneumonia? A multicentre study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Cuquemelle</surname><given-names>E.</given-names></name><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Soulis</surname><given-names>F.</given-names></name><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Villers</surname><given-names>D.</given-names></name><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Roche-Campo</surname><given-names>F.</given-names></name><xref ref-type="aff" rid="Aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Ara Somohano</surname><given-names>C.</given-names></name><xref ref-type="aff" rid="Aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Fartoukh</surname><given-names>M.</given-names></name><xref ref-type="aff" rid="Aff6">6</xref></contrib><contrib contrib-type="author"><name><surname>Kouatchet</surname><given-names>A.</given-names></name><xref ref-type="aff" rid="Aff7">7</xref></contrib><contrib contrib-type="author"><name><surname>Mourvillier</surname><given-names>B.</given-names></name><xref ref-type="aff" rid="Aff8">8</xref></contrib><contrib contrib-type="author"><name><surname>Dellamonica</surname><given-names>J.</given-names></name><xref ref-type="aff" rid="Aff9">9</xref></contrib><contrib contrib-type="author"><name><surname>Picard</surname><given-names>W.</given-names></name><xref ref-type="aff" rid="Aff10">10</xref></contrib><contrib contrib-type="author"><name><surname>Schmidt</surname><given-names>M.</given-names></name><xref ref-type="aff" rid="Aff11">11</xref></contrib><contrib contrib-type="author"><name><surname>Boulain</surname><given-names>T.</given-names></name><xref ref-type="aff" rid="Aff12">12</xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Brun-Buisson</surname><given-names>C.</given-names></name><address><phone>+33-1-49812391</phone><fax>+33-1-42079943</fax><email>christian.brun-buisson@hmn.aphp.fr</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><collab>A/H1N1 REVA-SRLF Study Group</collab></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="GRID">grid.410511.0</institution-id><institution-id institution-id-type="ISNI">0000000121497878</institution-id><institution>Service de Réanimation médicale, Medical Intensive Care Unit, GH Henri Mondor, AP-HP,</institution><institution>Université Paris-Est Créteil,</institution></institution-wrap>Créteil, France</aff><aff id="Aff2"><label>2</label>Medical Intensive Care Unit, Centre Hospitalo-Universitaire Charles Nicolle, Rouen, France</aff><aff id="Aff3"><label>3</label><institution-wrap><institution-id institution-id-type="GRID">grid.277151.7</institution-id><institution-id institution-id-type="ISNI">0000000404720371</institution-id><institution>Medical Intensive Care Unit,</institution><institution>Centre Hospitalo-Universitaire Hotel-Dieu,</institution></institution-wrap>Nantes, France</aff><aff id="Aff4"><label>4</label><institution-wrap><institution-id institution-id-type="GRID">grid.413396.a</institution-id><institution-id institution-id-type="ISNI">0000000417688905</institution-id><institution>Polyvalent Intensive Care Unit,</institution><institution>Hospital Santa Creu I Sant Pau,</institution></institution-wrap>Barcelona, Spain</aff><aff id="Aff5"><label>5</label>Medical Intensive Care Unit, Centre Hospitalo-Universitaire A. Michallon, Grenoble, France</aff><aff id="Aff6"><label>6</label><institution-wrap><institution-id institution-id-type="GRID">grid.50550.35</institution-id><institution-id institution-id-type="ISNI">0000000121754109</institution-id><institution>Medical Intensive Care Unit,</institution><institution>APHP, Centre Hospitalo-Universitaire Tenon, AP-HP,</institution></institution-wrap>Paris, France</aff><aff id="Aff7"><label>7</label><institution-wrap><institution-id institution-id-type="GRID">grid.411147.6</institution-id><institution-id institution-id-type="ISNI">0000000404720283</institution-id><institution>Medical Intensive Care Unit,</institution><institution>Centre Hospitalo-Universitaire,</institution></institution-wrap>Angers, France</aff><aff id="Aff8"><label>8</label><institution-wrap><institution-id institution-id-type="GRID">grid.50550.35</institution-id><institution-id institution-id-type="ISNI">0000000121754109</institution-id><institution>Medical Intensive Care Unit,</institution><institution>APHP, Centre Hospitalo-Universitaire Bichat-Claude Bernard, AP-HP,</institution></institution-wrap>Paris, France</aff><aff id="Aff9"><label>9</label>Medical Intensive Care Unit, Centre Hospitalo-Universitaire Archet 1, Nice, France</aff><aff id="Aff10"><label>10</label>Polyvalent Intensive Care Unit, Centre Hospitalier F. Mitterand, Pau, France</aff><aff id="Aff11"><label>11</label><institution-wrap><institution-id institution-id-type="GRID">grid.411439.a</institution-id><institution-id institution-id-type="ISNI">0000000121509058</institution-id><institution>Medical Intensive Care Unit,</institution><institution>APHP, Centre Hospitalo-Universitaire Pitié-Salpétrière, Paris, AP-HP,</institution></institution-wrap>Paris, France</aff><aff id="Aff12"><label>12</label><institution-wrap><institution-id institution-id-type="GRID">grid.413932.e</institution-id><institution-id institution-id-type="ISNI">0000 0004 1792 201X</institution-id><institution>Medical ICU,</institution><institution>Centre Hospitalier Régional,</institution></institution-wrap>Orléans, France</aff></contrib-group><pub-date pub-type="epub"><day>3</day><month>3</month><year>2011</year></pub-date><pub-date pub-type="ppub"><year>2011</year></pub-date><volume>37</volume><issue>5</issue><fpage>796</fpage><lpage>800</lpage><history><date date-type="received"><day>21</day><month>11</month><year>2010</year></date><date date-type="accepted"><day>27</day><month>11</month><year>2010</year></date></history><permissions><copyright-statement>© Copyright jointly held by Springer and ESICM 2011</copyright-statement><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.</license-p></license></permissions><abstract id="Abs1"><sec><title>Purpose</title><p>To determine whether procalcitonin (PCT) levels could help discriminate isolated viral from mixed (bacterial and viral) pneumonia in patients admitted to the intensive care unit (ICU) during the A/H1N1v2009 influenza pandemic.</p></sec><sec><title>Methods</title><p>A retrospective observational study was performed in 23 French ICUs during the 2009 H1N1 pandemic. Levels of PCT at admission were compared between patients with confirmed influenzae A pneumonia associated or not associated with a bacterial co-infection.</p></sec><sec><title>Results</title><p>Of 103 patients with confirmed A/H1N1 infection and not having received prior antibiotics, 48 (46.6%; 95% CI 37–56%) had a documented bacterial co-infection, mostly caused by <italic>Streptococcus pneumoniae</italic> (54%) or <italic>Staphylococcus aureus</italic> (31%). Fifty-two patients had PCT measured on admission, including 19 (37%) having bacterial co-infection. Median (range 25–75%) values of PCT were significantly higher in patients with bacterial co-infection: 29.5 (3.9–45.3) versus 0.5 (0.12–2) μg/l (<italic>P</italic> < 0.01). For a cut-off of 0.8 μg/l or more, the sensitivity and specificity of PCT for distinguishing isolated viral from mixed pneumonia were 91 and 68%, respectively. Alveolar condensation combined with a PCT level of 0.8 μg/l or more was strongly associated with bacterial co-infection (OR 12.9, 95% CI 3.2–51.5; <italic>P</italic> < 0.001).</p></sec><sec><title>Conclusions</title><p>PCT may help discriminate viral from mixed pneumonia during the influenza season. Levels of PCT less than 0.8 μg/l combined with clinical judgment suggest that bacterial infection is unlikely.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Procalcitonin</kwd><kwd>Pneumonia</kwd><kwd>A/H1N1v influenza</kwd><kwd>Bacterial infection</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© Copyright jointly held by Springer and ESICM 2011</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc><affiliations><list><country><li>Espagne</li><li>France</li></country><region><li>Aquitaine</li><li>Auvergne-Rhône-Alpes</li><li>Haute-Normandie</li><li>Nouvelle-Aquitaine</li><li>Provence-Alpes-Côte d'Azur</li><li>Rhône-Alpes</li><li>Région Normandie</li></region><settlement><li>Grenoble</li><li>Nice</li><li>Pau</li><li>Rouen</li></settlement></list><tree><country name="France"><noRegion><name sortKey="Cuquemelle, E" sort="Cuquemelle, E" uniqKey="Cuquemelle E" first="E." last="Cuquemelle">E. Cuquemelle</name></noRegion><name sortKey="Ara Somohano, C" sort="Ara Somohano, C" uniqKey="Ara Somohano C" first="C." last="Ara Somohano">C. Ara Somohano</name><name sortKey="Boulain, T" sort="Boulain, T" uniqKey="Boulain T" first="T." last="Boulain">T. Boulain</name><name sortKey="Brun Buisson, C" sort="Brun Buisson, C" uniqKey="Brun Buisson C" first="C." last="Brun-Buisson">C. Brun-Buisson</name><name sortKey="Dellamonica, J" sort="Dellamonica, J" uniqKey="Dellamonica J" first="J." last="Dellamonica">J. Dellamonica</name><name sortKey="Fartoukh, M" sort="Fartoukh, M" uniqKey="Fartoukh M" first="M." last="Fartoukh">M. Fartoukh</name><name sortKey="Kouatchet, A" sort="Kouatchet, A" uniqKey="Kouatchet A" first="A." last="Kouatchet">A. Kouatchet</name><name sortKey="Mourvillier, B" sort="Mourvillier, B" uniqKey="Mourvillier B" first="B." last="Mourvillier">B. Mourvillier</name><name sortKey="Picard, W" sort="Picard, W" uniqKey="Picard W" first="W." last="Picard">W. Picard</name><name sortKey="Schmidt, M" sort="Schmidt, M" uniqKey="Schmidt M" first="M." last="Schmidt">M. Schmidt</name><name sortKey="Soulis, F" sort="Soulis, F" uniqKey="Soulis F" first="F." last="Soulis">F. Soulis</name><name sortKey="Villers, D" sort="Villers, D" uniqKey="Villers D" first="D." last="Villers">D. Villers</name></country><country name="Espagne"><noRegion><name sortKey="Roche Campo, F" sort="Roche Campo, F" uniqKey="Roche Campo F" first="F." last="Roche-Campo">F. Roche-Campo</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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