Can Procalcitonin Level Predict the Development of Clostridium difficile Infection?

Abstract

SESSION TITLE: ICU Infections Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM 02:30 PM PURPOSE: Clostridium difficile associated diarrhea (CDAD) is a significant cause of morbidity and mortality among elderly patients. The Procalcitonin (PCT) level accurately predicted blood culture positivity in patients with CAP. PCT level has been shown to correlate well with bacterial infections, but little is known of its role in CDAD. We want to evaluate for any association between PCT levels (prior to development of diarrhea) and CDAD. Our Hypothesis is that higher value of PCT (any bacterial source) is a good predictor for development of CDAD. METHODS: We have collected and analyzed data from all admitted patients from September to December 2013 who developed significant diarrhea during their hospital stay. Inclusion criteria were testing for CDAD (either Toxin or PCR) and PCT levels prior to the onset of diarrhea. 56 patients met our inclusion criteria. Patients (n=8) who had concurrent positive blood culture were excluded. Total of 48 patient’s data were analysis. Study subjects were divided into two groups based on Cdiff test (positive or negative). The maximum PCT level prior to the Cdiff test was used. RESULTS: Total of 48 patients were analyzed. 44% were female with a mean age of 64. Maximum PCT level varied from 0.05 to 56 with a mean of 5.04. 12 patients had positive Cdiff test while the rest were negative. An independent sample t-test done between these two groups yielded a statistically significant difference in mean maximal PCT level (2.08 vs 13.9, p<0.05). There was no significant difference between the mean WBC count on the day of Cdiff test (14.3 vs. 14.9, p=.788). CONCLUSIONS: Procalcitonin has been used to guide antibiotic therapy in clinical algorithms for respiratory infections, sepsis, postoperative infections and ventilator-associated pneumonia. Dr. Rao et al (PLoS ONE 8(3): e58265. doi:10.1371/0058265) reported correlation between PCT level and CDAD severity; however in that study the PCT levels were done on the same day or during the treatment. Based on our study, we report that patients with higher prior PCT level are at risk for development of CDAD, although larger study is needed to validate these results as well as define the cut-off values. The reason for the difference is unclear, but may be either due to longer duration of antibiotics for higher PCT or sequelae of sepsis induced immunosuppression. CLINICAL IMPLICATIONS: Procalcitonin level can be useful biomarker to predict development of CDAD and can guide for early detection and management of CDAD. DISCLOSURE: The following authors have nothing to disclose: Rakesh Vadde, Abhisekh Sinha Ray, Mohammed Raihan Azad, Vikram Oke, Bikash Bhattarai, Saurav Pokharel, Bhradeev Sivasambu, Meera Yogarajah, Ahmed Bakhit, Shivjitinder Sidhu, Meenakshi Ghosh, Marie Frances Schmidt No Product/Research Disclosure Information Copyright © 2014 American College of Chest Physicians FREE TO VIEW