• Zafar Iqbal-Mirza Sadaf S Servicio de Medicina Interna, Complejo Hospitalario Universitario de Toledo, Toledo, España., Vicente Serrano Romero de Ávila, Raquel Estévez-González, Dara Rodríguez-González, Eva Heredero-Gálvez, and Agustín Julián-Jiménez.
• Servicio de Medicina Interna, Complejo Hospitalario Universitario de Toledo, Toledo, España.
• Enferm Infecc Microbiol Clin (Engl Ed). 2019 Nov 1; 37 (9): 560-568.

ObjectivesTo analyse and compare the ability of procalcitonin (PCT), C-reactive protein (CRP) and leukocytes to differentiate true bacteraemia from contaminated blood cultures in patients seen in the emergency department (ED) for an episode of infectious disease.MethodsObservational, retrospective and descriptive analytical study of all blood cultures with positive growth extracted in an ED in adult patients (≥18 years) during 2016 and 2017. The follow-up was carried out over a 30-day period to calculate the predictive power and the prognostic performance for true bacteraemia.ResultsA total of 266 blood cultures with positive growth were included in the study. Out of these, 154 (57.9%) were considered true bacteraemia and 112 (42.1%) were considered to be contaminated blood cultures. The area under the Receiver Operating Characteristic curve (AUC-ROC) for PCT to predict true bacteraemia was 0.983 (95% CI: 0.972-0.994; P<0.001) and, considering a cut-off value of≥0.43 ng/ml, PCT achieved 94% sensitivity, 91% specificity, positive predictive value of 94%, and negative predictive value of 92%. The AUC-ROC obtained for CRP was 0.639 (95% CI: 0.572-0.707, P<.001), for leukocytes of 0.693 (95% CI: 0.630-0.756, P<.001) and for immature leukocytes (>10% bands) of 0.614 (95% CI: 0.547-0.682, P<.001). The mean values for PCT were 3.44 (SD 6.30) ng/ml in true bacteraemia vs. 0.16 (SD 0.18) ng/ml in contaminated blood cultures (P<.001).ConclusionsIn blood cultures with positive growth extracted in an ED, PCT achieves the best prognostic performance of true bacteraemia vs. contaminated blood cultures, better than CRP and leukocytes.Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

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