Can procalcitonin help identify associated bacterial infection in patients with severe influenza pneumonia? A multicentre study
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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”
From The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. (2016) · cites this paper as [34]
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
- PMC
- PMC7080069
- 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
- bronze
- doi.org
- Licence
- 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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