Previous studies have suggested that procalcitonin is a reliable marker for predicting bacteremia. However, these studies have had relatively small sample sizes or focused on a single clinical entity. The primary endpoint of this study was to investigate the diagnostic accuracy of procalcitonin for predicting or excluding clinically relevant pathogen categories in patients with suspected bloodstream infections. The secondary endpoint was to look for organisms significantly associated with internationally validated procalcitonin intervals. We performed a cross-sectional study that included 35,343 consecutive patients who underwent concomitant procalcitonin assays and blood cultures for suspected bloodstream infections. Biochemical and microbiological data were systematically collected in an electronic database and extracted for purposes of this study. Depending on blood culture results, patients were classified into 1 of the 5 following groups: negative blood culture, Gram-positive bacteremia, Gram-negative bacteremia, fungi, and potential contaminants found in blood cultures (PCBCs). The highest procalcitonin concentration was observed in patients with blood cultures growing Gram-negative bacteria (median 2.2 ng/mL [IQR 0.6–12.2]), and the lowest procalcitonin concentration was observed in patients with negative blood cultures (median 0.3 ng/mL [IQR 0.1–1.1]). With optimal thresholds ranging from ≤0.4 to ≤0.75 ng/mL, procalcitonin had a high diagnostic accuracy for excluding all pathogen categories with the following negative predictive values: Gram-negative bacteria (98.9%) (including enterobacteria [99.2%], nonfermenting Gram-negative bacilli [99.7%], and anaerobic bacteria [99.9%]), Gram-positive bacteria (98.4%), and fungi (99.6%). A procalcitonin concentration ≥10 ng/mL was associated with a high risk of Gram-negative (odds ratio 5.98; 95% CI, 5.20–6.88) or Gram-positive (odds ratio 3.64; 95% CI, 3.11–4.26) bacteremia but dramatically reduced the risk of PCBCs or fungemia. In this large real-life setting experience with more than 35,000 patients, procalcitonin was highly effective at excluding bloodstream infections regardless of pathogen categories. The results from our study are limited by its cross-sectional design and deserve to be validated in prospective longitudinal studies.

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cWe report the first case of Paenibacillus glucanolyticus infection in a 65-year-old patient with type 2 diabetes who developed a cardiac device-related endocarditis. The identification of the isolate was performed using phenotypic methods, including mass spectrometry-based methods, and 16S rRNA gene sequencing. CASE REPORT In November 2012, a 65-year-old woman with type 2 diabetes was admitted to the University Hospital Center of Nancy because of a localized pacemaker pocket infection. The pacemaker was implanted 12 years before because of the patient's high-degree atrioventricular block. The generator was replaced in 2010. Since January 2012, the patient had reported signs of inflammation at the site of pacemaker implantation. In October 2012, the patient, who was afebrile, was admitted to another hospital with local signs of inflammation at the generator pocket with skin fistulization and purulent discharge. Pocket abscess drainage was then performed, and a pus specimen was sent to the local laboratory. The patient, who was allergic to penicillin, was treated with trimethoprim-sulfamethoxazole and erythromycin for 10 days. Gram staining of the pus sample did not reveal any organism, while a rod-shaped bacterium that appeared to be Gram negative was obtained by culture. This isolate was identified first as Cronobacter sakazakii (Vitek 2 GN card; bioMérieux, Marcy l'Etoile, France) and finally as Aeromonas salmonicida (API ID 32GN kit; bioMérieux).On admission to our hospital, the patient was afebrile, and physical examination revealed an inflammatory pacemaker pocket with a purulent discharge. No other symptoms were noted. The white blood cell count was 13.8 ϫ 10 9 /liter with 62% neutrophils. The serum C-reactive protein level was normal, while the serum procalcitonin level was slightly elevated. Transesophageal echocardiography revealed a hyperechogenic mass on the distal portion of the right atrial lead compatible with a vegetation. The patient underwent implantation of an epicardial pacemaker prior to percutaneous removal of the generator and the atrial and ventricular leads. The presence of a vegetation attached to the atrial lead was confirmed macroscopically. The patient was treated with ceftriaxone (2 g intravenously [i.v.] once a day) for 42 days. Four sets of blood cultures were drawn before the onset of antibiotic therapy. The leads as well as a pus sample obtained from the pacemaker pocket were sent for microbiological analysis.Specimens taken during the intervention were processed using standard methods and inoculated onto tryptic soy agar with 5% sheep blood (bioMérieux) incubated at 37°C in air and brucella blood agar with hemin and vitamin K1 (Becton, Dickinson, Le Pont de Claix, France) incubated at 37°C anaerobically. In addition, brain heart infusion and Rosenow broths (Bio-Rad, Marnesla-Coquette, France) were inoculated and incubated at 37°C, respectively, in air and anaerobically. Part of the vegetation embedding the atrial lead was also sampled for broad-range bacterial 16S rRNA gene PCR....