Cited by 109Sepsis Diagnosis and TreatmentInfluenza Virus Research StudiesPneumonia and Respiratory Infections

Can procalcitonin help identify associated bacterial infection in patients with severe influenza pneumonia? A multicentre study

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Cuquemelle, E., Soulis, F., Villers, D., Roche-Campo, F., Ara Somohano, C., Fartoukh, M., Kouatchet, A., Mourvillier, B. +6 more·2011·Intensive Care Medicine

Abstract

Purpose 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.Methods 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.Results 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 Streptococcus pneumoniae (54%) or Staphylococcus aureus (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 (P < 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; P < 0.001).Conclusions 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.

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  • Only three studies excluded participants based on antibiotic use and reported coinfection rates of 12.2%, 26.7%, and 46.6%.

    “Only three studies excluded participants based on antibiotic use and reported coinfection rates of 12·2%, 26·7%, and 46·6%.28, 34, 36”
  • A French study concluded that procalcitonin levels of 0·8 μg/l or more discriminated well between isolated viral and mixed bacterial and viral pneumonia in patients with H1N1 influenza pneumonia admitted to hospital.

    “A French study measured levels of procalcitonin (PCT) – a recognised marker of bacterial infection, in patients with H1N1 influenza pneumonia admitted to hospital and was able to conclude that levels of 0·8 μg/l or more discriminated well between isolated viral and mixed bacterial and viral pneumonia.”

    From Bacterial and viral infections associated with influenza (2013) · cites this paper as [39]

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Authors
Cuquemelle, E., Soulis, F., Villers, D., Roche-Campo, F., Ara Somohano, C., Fartoukh, M., Kouatchet, A., Mourvillier, B., Dellamonica, J., Picard, W., Schmidt, M., Boulain, T., Brun-Buisson, C., & A/H1N1 REVA-SRLF Study Group
Affiliations
  • Hôpital Charles-Nicolle (FR)
  • Centre Hospitalier Universitaire de Nantes (FR)
  • Assistance Publique – Hôpitaux de Paris (FR)
  • Centre Hospitalier Universitaire d'Angers (FR)
  • Centre Hospitalier Universitaire de Nice (FR)
  • Centre Hospitalier De Pau (FR)
  • Centre hospitalier universitaire d'Orléans (FR)
Venue
Intensive Care Medicine
Published
2011-03-03
Volume
37
Issue
5
Pages
796-800
ISSN
  • 0342-4642 (ISSN-L)
  • 1432-1238
OpenAlex
W1997205563
Cited by
109
References
15
Citations by year
2026: 2 · 2025: 2 · 2024: 4 · 2023: 9 · 2022: 6 · 2021: 10 · 2020: 9 · 2019: 7 · 2018: 4 · 2017: 6 · 2016: 5 · 2015: 11 · 2014: 8 · 2013: 6 · 2012: 17
FWCI
8.19
Type
journal article
Language
en
Open access
Locations
  • Intensive Care Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Société de Réanimation de Langue Française
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
Keywords
procalcitonin, bacterial co-infection, influenza pneumonia, H1N1 influenza, Streptococcus pneumoniae, Staphylococcus aureus, intensive care unit patients, diagnostic biomarkers, 2009 H1N1 pandemic
MeSH terms
Adult, Bacterial Infections, Calcitonin, Female, France, Humans, Influenza, Human, Male, Middle Aged, Pneumonia, Protein Precursors, Retrospective Studies, Sensitivity and Specificity, Severity of Illness Index, Biomarkers, Calcitonin Gene-Related Peptide, Influenza A Virus, H1N1 Subtype

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