Clinical utility of procalcitonin as a marker of sepsis: a potential predictor of causative pathogens.

OBJECTIVE: Sepsis is one of the leading causes of mortality in critically ill patients, and providing a timely diagnosis and early intervention is necessary for successful treatment. Procalcitonin (PCT) may be a better marker of sepsis than conventional inflammatory markers. The aim of this study was to evaluate the clinical utility of the PCT level as a marker of sepsis. METHODS: Forty-five patients with sepsis, 24 patients with pneumonia who did not meet the SIRS criteria (PN) and 56 controls were enrolled in this study. The levels of PCT and other serum markers were measured, and their utility as markers of sepsis was assessed. RESULTS: The serum PCT levels exhibited statistically significant differences between the three groups (p<0.0001). The PCT levels in the sepsis group (29.3 ± 85.3 ng/mL) were significantly higher (p<0.001) than those observed in the PN group (0.34 ± 8.6 ng/mL) and the control group (0.74 ± 2.1 ng/mL), according to a post hoc analysis. There were no differences in the white blood cell (WBC) counts or C-reactive protein (CRP) levels between the three groups. Fourteen of the 45 patients with sepsis had positive microbiological blood cultures (Gram-positive cocci [GPC] in seven patients, Gram-negative rods [GNR] in six patients, other types of bacteria in one patient). The 13 patients with GNR or GPC were categorized into the GNR group or GPC group according to the identified pathogens. The serum PCT levels were significantly higher in the GNR group (149.8 ± 199.7 ng/mL) than in the GPC group (19.1 ± 41.8 ng/mL) (p<0.05), although there were no differences in the WBC counts or CRP levels between these groups. When the cut-off value for the PCT level was set at 16.9 ng/mL, the sensitivity and specificity for the detection of GNR infection were 85.7% and 83.3%, respectively. CONCLUSION: The PCT level is a potentially useful marker of the type of causative pathogen in patients with sepsis whose measurement may facilitate the selection of appropriate empiric antibiotic treatment.

[Clinical and microbiological features of patients with pulmonary nontuberculous mycobacterial infection].

BACKGROUNDS: The prevalence of pulmonary nontuberculous mycobacterial infection (pNTM) is currently increasing. Furthermore, its clinical feature is reported to be gradually changing. However, few reports to clarify the current features of pNTM have been published. The aim of this study is to investigate microbiological and clinical features of pNTM. PATIENTS AND METHODS: This study was a retrospective observational study. Patients with pNTM visited to Dokkyo Medical University Koshigaya Hospital between January 2009 and December 2010 were enrolled. All patients fulfilled the diagnostic criteria in Japanese guidelines for nontuberculous mycobacterial pulmonary disease published in 2008. Medical records were reviewed to obtain information about the enrolled patients. RESULTS: Total 143 patients (49 males and 94 females, age 67 +/- 10 yrs) were enrolled in this study. Only 11.9% of patients had malignant diseases and 5.6% had diabetes mellitus whereas 79% had no comorbidity. Nearly 60% of patients showed normal BMI. At the time of diagnosis, 52.0% of patients had no symptom whereas 22.3% had cough and/or sputum, and 7.1% had hemoptysis. The results of smear examination with acid-fast staining were negative in 80.4%, +/- in 9.8%, 1 + in 7.7% and 2 + in 2.1%. Causative pathogens detected with acid-fast bacillus culture were Mycobacterium avium (M. avium) (74.8%), M. intracellulare (14.0%), M. fortuitum (3.5%), M. abscessus (2.8%), M. kansasii (2.8%) and others. CONCLUSION: This study showed that majority of patients had no symptoms and/or negative results of smear examination with acid-fast staining. It is crucial to consider these facts when a diagnostic test of pNTM is performed.