22Apr 2017

DIAGNOSTIC USEFULNESS OF PROCALCITONIN AND C-REACTIVE PROTEIN IN GRAM NEGATIVE BACTERIAL INFECTIONS.

  • Senior Specialist Biomedical Scientist, Blood Sciences Department, Frimley Park Hospital NHS Trust, Camberley, Surrey, GU 16 7UJ ,UK.
  • Research Scholar, Department of Biochemistry, VelsUniveristy, Pallavaram, Chennai ? 600 117. Tamil Nadu, India.
  • Director of Laboratory Services & Consultant Biochemist, Techmed Health Care & Diagnostic Pvt Ltd. Siva Building, Krishna Street, Opp. Joyalukas, North Usman Road, T.Nagar, Chennai 600 017.
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Any biomarker used to substantiate bacterial infections should aid in the rapid diagnosis, initiation of treatment and during prognosis monitoring. As of now a wide range of biomarkers have been established and more researches are being done in this field. Markers such as ESR, C-Reactive Protein, Procalcitonin and Leucocyte count have been extensively studied for a wide range of bacterial infections. However, studies related to biomarkers, C-Reactive Protein and Procalcitonin have been found to be very useful in early diagnosis, treatment and monitoring the effect of antibiotic treatment, Both the above markers were found to be very useful in the diagnosis of gram negative bacterial infection compared to other type of infections such as by gram positive. Moreover, both these markers are found to be useful in infective fever, meningitis, sepsis, critical care patients, graft acceptance/rejection and in pneumonia. This review article present the various research findings related to the clinical usefulness of these biomarkers in the diagnosis of infections caused by gram negative bacteria.


  1. Brodsk? H, Mal?čkov? K, Ad?mkov? V, Ben?kov? H, ?ťastn? MM, Zima T.Significantly higher procalcitonin levels could differentiate Gram-negative sepsis from Gram-positive and fungal sepsis.ClinExp Med. 2013;13(3):165-70.
  2. Shun Yuan Guo, Yin Zhou, Qing Feng Hu, Jiong Yao, and Hong Wang.Procalcitonin Is a Marker of Gram-Negative Bacteraemia in Patients With Sepsis.Am J Med Sci. 2015; 349(6): 499?504.
  3. Shuhua Li, HengmoRong, Qinliang Guo,1Yifei Chen, Guqing Zhang, and JiongYang.Serumprocalcitonin levels distinguish Gram-negative bacterial sepsis from Gram-positive bacterial and fungal sepsis.J Res Med Sci. 2016; 21: 39.
  4. Christian Leli,?Marta Ferranti,?AmedeoMoretti,?ZainabSalim Al Dhahab,?Elio Cenci,?and AntonellaMencacci. Procalcitonin Levels in Gram-Positive, Gram-Negative, and Fungal Bloodstream Infections.Disease Markers.?2015 : 8.
  5. Ekaterina?Chernevskaya, Natalia?Beloborodova and Tatyana?Vostrikova. Can procalcitonin reflect the etiology of the bacteraemia?Critical Care. 2007; 11( 4):P17.
  6. Helena Brodsk?, Karin Mal?čkov?, V?clavaAd?mkov?,Tom??Zima.Circulating Inflammatory Mediators during Start of Fever in Differential Diagnosis of Gram-Negative and Gram-Positive Infections in Leukopenic Rats. Journal of research in medical sciences.2016; 21(1):39.
  7. Eva Tavares,Rosario Maldonado, Maria L Ojeda, Francisco J Mi?ano.Recognition of bacterial infection by innate immune sensors.Clin Microbiol Rev. 2005; 18(3): 521?540.
  8. Yuji Watanabe,Nozomi Oikawa, Maya Hariu, RyotaFuke, Masafumi Seki Ability of procalcitonin to diagnose bacterial infection and bacteria types compared with blood culture findings.Int J Gen Med. 2016; 9: 325?331.
  9. Sandri MT, Passerini R, Leon ME, Peccatori FA, Zorzino L, Salvatici M, Riggio D, Cassatella C, Cinieri S, MartinelliG.Procalcitonin as a useful marker of infection in hemato-oncological patients with fever.Anticancer Res. 2008;28(5B):3061-5.
  10. YanhuiZhu,Yulin Yuan, and Huayi Huang. Comparison of serum procalcitonin in respiratory infections and bloodstream infections. Int J ClinExp Med. 2015; 8(11): 21586?21592.
  11. Charles PE, Ladoire S, Aho S, Quenot JP, Doise JM, Prin S, Olsson NO, Blettery B. Serum procalcitonin elevation in critically ill patients at the onset of bacteraemia caused by either G- or Gram positive bacteria. BMC Infect Dis. 2008 26;8:38.
  12. Koivula I, H?m?l?inen S, Jantunen E, Pulkki K, Kuittinen T, Nousiainen T, Juutilainen A. Elevated procalcitonin predicts Gram-negative sepsis in haematological patients with febrile neutropenia. Scand J Infect Dis. 2011;43(6-7):471-8.
  13. Philipp?Schuetz, Werner?Albrich and Beat?Muelle.Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Medicine20119:107
  14. SavitriKibe, Kate Adams, Gavin Barlow. Diagnostic and prognostic biomarkers of sepsis in critical care. J AntimicrobChemother. 2011; 66 (2): ii33-ii40. Citation
Savitri Kibe, Kate Adams, Gavin Barlow; Diagnostic and prognostic biomarkers of sepsis in critical care. J Antimicrob Chemother 2011; 66 (suppl_2): ii33-ii40. doi: 10.1093/jac/dkq523 Download citation file: ? 2017 Oxford University Press ?
  1. XiaofengLuo, JinhuaRen, ZhizheChen, TingYang and JiandaEarly Quantitative Determination of Serum Procalcitonin Can Help Distinguishing Strains of Different Bloodstream Infections in Patients with Hematologic Diseases.Blood. 2016;128:3703.
  2. Vikas Mishra, JehangirSorabjee. Procalcitoninlevels in salmonella infection. Indian J Crit Care Med. 2015 ; 19(8): 471?473.
  3. M. Svaldi, J. Hirber, A.I. Lanthaler, O. Mayr.Procalcitonin-reduced sensitivity and specificity in heavily leucopenic and immunosuppressed patients.Br J Haematol.?2001;115(1):53-7.
  1. Hammer, F. Meisner, P. Dirschedl|, P. Fraunberger, B. Meiser, B. Reichart, C. Hammer Procalcitonin for differential diagnosis of graft rejection and infection in patients with heart and/or lung grafts. Intensive Care Med. 2000;26( 2):S182-6.
  2. I. Morales Casado, F. Moreno Alonso, A.L. Ju?rez Belaunde, E. Heredero G?lvez, O. Talavera Encinas, A. Juli?n-Jim?nez.Ability of procalcitonintopredictbacterial meningitis in theemergencydepartment .Neurologia 2016;31:9-17.
  3. Procalcitonin Role in Differential Diagnosis of Infection Stages and Non Infection Inflammation. Research Article. Pakistan Journal of Biological Sciences, 2009.12: 393-396.
  4. Matthias?Klingele, Hagen?Bomberg, Simone?Schuster, Hans-Joachim?Sch?fers and Heinrich?Volker?Groesdonk. Prognostic value of procalcitonin in patients after elective cardiac surgery: a prospective cohort study. Annals of Intensive Care. 2016; 6:116.
  5. DjillaliAnnane, VirginieMaxime Procalcitonin levels to guide antibiotic therapy in adults with non-microbiologically proven apparent severe sepsis: a randomised controlled trial. BMJ Open. 2013 14;3(2).
  6. IliasPorfyridis, GeorgiosGeorgiadis, Paris Vogazianos, GeorgiosMitis and Andreas Georgiou. C-Reactive Protein, Procalcitonin, Clinical Pulmonary Infection Score, and Pneumonia Severity Scores in Nursing Home Acquired Pneumonia.Respiratory Care. 2014;59 (4):574-581.
  7. Irene Alexandrakicorresponding author1 and Carlos Palacio1. Gram-negative versus Gram-positive bacteraemia: what is more alarmin(g)? Crit Care. 2010; 14(3): 161.
  8. Sormunen P1, Kallio MJ, Kilpi T, Peltola H. C-reactive protein is useful in distinguishing Gram stain-negative bacterial meningitis from viral meningitis in children. J Pediatr. 1999;134(6):725-9.
  9. Flores JM, Jim?nez PI, Rinc?n D, M?rquez J, Navarro H, Mu?oz A, Murillo F. C reactive protein as marker of infection among patients with severe closed trauma. 2001 ;19(2):61-5.
  10. Ligtenberg PC, Hoepelman IM, Oude Sogtoen GA, Dekker AW, van der Tweel I, Rozenberg-Arska M, Verhoef J. C-reactive protein in the diagnosis and management of infections in granulocytopenic and non-granulocytopenic patients. Eur J ClinMicrobiol Infect Dis. 1991;10(1):25-31.
  11. Tan SS, Ng PM, Ho B, Ding JL. The antimicrobial properties of C-reactive protein (CRP). J Endotoxin Res. 2005;11(4):249-56.
  12. Alexander J. Szalai,J. L. VanCott, Jerry R. McGhee, John E. Volanakis, and William H. Benjamin, Jr. Human C-Reactive Protein Is Protective against Fatal Salmonella entericaSerovarTyphimurium Infection in Transgenic Mice. Infect Immun. 2000; 68(10): 5652?5656.
  13. Concentrations of procalcitonin and C-reactive protein, white blood cell count, and the immature-to-total neutrophil ratio in the blood of neonates with nosocomial infections: Gram-negative bacilli vs coagulase-negative staphylococci. Eur J ClinMicrobiol Infect Dis. 2011 Mar; 30(3): 455?457.
  14. Pourcyrous MBada HS, Korones SB, Baselski V, Wong SP. Significance of serial C-reactive protein responses in neonatal infection and other disorders. 1993;92(3):431-5.
  15. GoranRajs, ZvezdanaFinzi-Yeheskel, AndreaRajs, MichaelC-Reactive Protein Concentrations in Cerebral Spinal Fluid in Gram-positive and Gram-negative Bacterial Meningitis.Med J Armed Forces India. 2005; 61(1): 13?15.
  16. Ryuzo Abe, ShigetoOda,TomohitoSadahiro, Masataka Nakamura, Yo Hirayama, Yoshihisa Tateishi, Koichiro Shinozaki, and Hiroyuki Hirasawa. Gram-negative bacteraemia induces greater magnitude of inflammatory response than Gram-positive bacteraemia. Crit Care. 2010; 14(2): R27.
  17. Ram Mohan Rao and Syam D Gopal. C-Reactive Protein - A critical Review. Int.J.Curr.Microbiol.App.Sci (2015) 4(12): 55-61
  18. Ng PM, Jin Z, Tan SS, Ho B, Ding JL. C-reactive protein: a predominant LPS-binding acute phase protein responsive to Pseudomonas infection. J Endotoxin Res. 2004;10(3):163-74.
  19. Khassawneh M, Khader Y, Abuqtaish N. Clinical features of neonatal sepsis caused by resistant Gram-negative bacteria. Pediatr Int. 2009;51(3):332-6.
  20. Mei-Yin?Lai, Ming-Horng?Tsai, Chiang-Wen?Lee, Ming-Chou?Chiang, Reyin?Lien,? Ren-Huei?Fu, Hsuan-Rong?Huang, Shih-Ming?Chu, en-Fu?Hsu.Characteristics of neonates with culture-proven bloodstream infection who have low levels of C-reactive protein (≦10?mg/L).BMC Infectious Diseases. 2015;15:320.
  21. Rabindran, Parakh H, Ramesh JK, Reddy P Comparative Study of Platelet count and C-Reactive Protein among Gram Positive, Gram Negative and Fungal Sepsis in Newborns. International Journal of Medical Research and Review.2015; 3(2). Guo SY1, Zhou Y, Hu QF, Yao J, Wang H.Procalcitonin Is a Marker of Gram-Negative Bacteraemia in Patients With Sepsis. Am J Med Sci. 2015 ;349(6):499-504.
  22. Ayşe İnci Investigation of Differences In CRP, PCT, WBC and MPV In Gram-Negative, Gram-Positive and Fungal Bloodstream Infections.DisMol Med. 2016; 4(4): 81-84
  23. Corrall, JC, Pepple, JM, Moxon, ER, Hughes, WT. C-reactive protein in spinal fluid of children with meningitis. J Pediatr. 1981;99:365?369.
  24. RickKapur, Katja M. J.Heitink-Poll?, LeendertPorcelijn, Arthur E. H.Bentlage, Marrie C. A.Bruin, RemcoVisser, DirkRoos, Richard B. M.Schasfoort, Masjade Haas, C. Ellenvan der Schoot and GesturVidarsson.C-reactive protein enhances IgG-mediated phagocyte responses and thrombocytopenia. Blood 2015 125:1793-1802C.
  25. AbdolkarimHamedi,HosainAyatollahi, and AliRezaAtaeeNakhaee..Evaluation of IL-6 and High Sensitive C Reactive Protein Value in CSF and Serum Children Suspected Meningitis Referred to Pediatric Emergency Room. Iranian Red Crescent Medical Journal. 2012; 14(12): 822-5.
  26. JunyanQu, XiaojuL?, Yanbin Liu, Xiaohui Wang .Evaluation of procalcitonin, C-reactive protein, interleukin-6 & serum amyloid A as diagnostic biomarkers of bacterial infection in febrile Indian J Med Res. 2015 Mar; 141(3): 315?321.
  27. HanyKmale Mickhael, Josef Zekry Attia, MahaYehia Kamel2 Role of clinical pulmonary infection score and serum C-reactive protein in detecting the efficacy of therapeutic choices in the management of Enterobacteraerogenes nosocomial pneumonia.original article . 2016?;? 3(1): 1-5.

[Rajeswari S and Swaminathan S. (2017); DIAGNOSTIC USEFULNESS OF PROCALCITONIN AND C-REACTIVE PROTEIN IN GRAM NEGATIVE BACTERIAL INFECTIONS. Int. J. of Adv. Res. 5 (Apr). 321-329] (ISSN 2320-5407). www.journalijar.com


Dr. S. Swaminathan
Director of Laboratory Services & Consultant Biochemist, Techmed Health Centre & Diagnostic (P) Ltd., 01, Siva Building, Krishna Street, Off North Usman Road, T.Nagar, Chennai - 600017

DOI:


Article DOI: 10.21474/IJAR01/3814      
DOI URL: http://dx.doi.org/10.21474/IJAR01/3814