1730. Can Positive Procalcitonin Levels Diagnose Severe Clostridium difficile-Associated Disease?
Session: Poster Abstract Session: Studies of the Interface of Host-Microbial Interaction
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Cdiff PCT poster.pdf (375.5 kB)
  • Background:   Clostridium difficile-associated disease (CDAD) is a major cause of morbidity in hospitalized patients whose clinical manifestations can vary in severity and there are no good biomarkers of severe disease.  Procalcitonin (PCT) is an FDA-approved biomarker for bacterial infections that has good specificity and sensitivity in sepsis and pneumonia, but its utility is unknown in CDAD.  Our objective was to evaluate the role of PCT levels as a diagnostic adjunct in the identification of severe CDAD as the first study of its kind.

    Methods: This was a retrospective chart review of all cases of CDAD in two urban inner city hospitals in New Jersey, in whom patients had a PCT level drawn within 24 hours of a confirmed CDAD infection, either by toxin or PCR, from January 1, 2011 to August 1, 2012.  Severity of CDAD was defined as WBCs>15, 000 cells/µL or creatinine change greater than 50% from baseline.  

    Results:   53 patients met the inclusion criteria and were enrolled in the study. Mean age was 69.1 years with a range of 20 to 97 years and 30 were females (56.6%). Thirty three (62.3%) patients met criteria for Severe CDAD.  In patients with severe CDAD, the sensitivity and specificity of a positive PCT result (defined as > 0.5 µg/L) were 97% and 75% respectively.  Positive Predictive Value and Negative Predictive Value were 0.86 and 0.94, respectively.

    Conclusion:    Positive PCT levels greater than 0.5 µg/L seem to be a good indicator of CDAD severity and may aid in early appropriate treatment on admission. Further prospective studies are needed to confirm these results in other clinical settings.

    Muhammad Afridi, MD1,2, Raymund Sison, M.D.2,3, Rabih Hallit, MD4, Neal Carlin, MD4, Joshua Gazo, MD4, Danish Ali, MD1, Debbie Mohammed, NP3, Jack Boghossian, MD4, Michael Lange, MD, MPH5 and Jihad Slim, MD3, (1)Infectious Disease, St. Michael's Medical Center, Newark, NJ, (2)Seton Hall University School of Health and Medical Sciences, South Orange, NJ, (3)Infectious Diseases, Saint Michael's Medical Center, Newark, NJ, (4)St. Michael's Medical Center, Newark, NJ, (5)Infectious Diseases, St. Joseph's Regional Medical Center, Paterson, NJ

    Disclosures:

    M. Afridi, None

    R. Sison, None

    R. Hallit, None

    N. Carlin, None

    J. Gazo, None

    D. Ali, None

    D. Mohammed, None

    J. Boghossian, None

    M. Lange, None

    J. Slim, None

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