Utility of initial procalcitonin values to predict urinary tract infection

Levine, Alexander; Tran, Midori; Shepherd, Jonathan; Naut, Edgar

doi:10.1016/j.ajem.2018.03.001

Cited by 34 publications

(23 citation statements)

References 34 publications

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“…This recommended strategy is not novel. As recently reported in the American Journal of Emergency Medicine , one retrospective analysis of UTIs found a negative predictive value of 91% for a low procalcitonin further bolstering the argument in favor of its use as an adjunct in the non-initiation of empiric antibiotics 42. Even more compelling, a RCT of nearly 200 ED patients found that a procalcitonin-based algorithm reduced antibiotic exposure by 30% without negative effects on clinical outcomes 38.…”

Section: Discussionmentioning

confidence: 87%

Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly

Pescatore

Niforatos

Rezaie³

et al. 2019

WestJEM

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An abnormal urinalysis in an elderly patient presenting to the emergency department (ED) with non-specific symptoms represents one condition that requires an evidence-informed approach to diagnosis and management of either asymptomatic bacteriuria or urinary tract infection (UTI). The emergency provider often will not have access to urine cultures, and the risks associated with antibiotic use in the elderly are not without potentially significant side effects. Methods: We performed a historical and clinical review of the growing body of literature suggesting measurable differences in the systemic immune response manifest among patients with asymptomatic pyuria and UTI, including increases in the pro-inflammatory cytokine interleukin-6 and the acute phase reactant procalcitonin. Results: Serum procalcitonin, a peptide that undergoes proteolysis into calcitonin, has been demonstrated to quickly and reliably rise in patients with severe bacterial infections, and may serve as a potentially sensitive and specific marker for identification of bacterial illness. Conclusion: In the absence of validated risk scores for diagnosing UTI in elderly patients presenting to the ED, there may be a role for the use of procalcitonin in this patient population.

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Section: Discussionmentioning

confidence: 87%

Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly

Pescatore

Niforatos

Rezaie³

et al. 2019

WestJEM

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“…Clinically, there is a need for a diagnostic biomarker for UTI, especially in T2DM. Other diagnostic biomarkers of bacterial UTIs such as serum procalcitonin 27 and CRP 28 are either non-specific for uropathogens, or cannot differentiate between them. The reverse pattern of blood NLR in non-T2DM patients supports the predictive ability of this blood marker for E. coli UTI in T2DM.…”

Section: Discussionmentioning

confidence: 99%

<p>Blood Neutrophil-to-Lymphocyte Ratio and Urine IL-8 Levels Predict the Type of Bacterial Urinary Tract Infection in Type 2 Diabetes Mellitus Patients</p>

Sharif-Askari¹,

Sharif-Askari²,

Guella³

et al. 2020

IDR

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Background: Extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the most common uropathogens causing UTI (urinary tract infection) in type 2 diabetes mellitus (T2DM). Circulatory inflammatory markers such as C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) are usually dysregulated during UTI. However, the differential regulation of these inflammatory signatures during E. coli and K. pneumoniae UTI in T2DM has not been determined. Methods: A case-control study on 466 patients was performed to investigate the inflammatory signatures indicative of ESBL-E. coli and K. pneumoniae UTIs in T2DM. Serum CRP levels and blood NLR for these patients were determined and associated with E. coli and K. pneumoniae ESBL uropathogen using multivariate logistic regression analysis. Urinary interleukin 8 (IL-8) levels were also assessed and associated with these two UTI uropathogens in T2DM. The association of the two ESBL-uropathogens with the survival outcomes of T2DM patients was also analyzed using Cox-proportional hazard model. Results: T2DM patients with ESBL-E. coli UTI had lower serum CRP levels (median, CRP mg/dL 33.7 vs 39.8, respectively; P=0.023) and higher blood NLR (median, NLR 3.2 vs 2.6, respectively; P=0.010) compared to those with K. pneumoniae UTIs (P<0.001). Moreover, in T2DM, the urinary IL-8 levels was higher in ESBL-E. coli compared to those with K. pneumoniae UTIs (P<0.0001). After adjusting for confounders, including age, gender, serum albumin, hemoglobulin, leukocytes, and platelet counts, T2DM patients with blood NLR ≥ 3.5 were at higher risk for ESBL-E. coli UTIs than ESBL-K. pneumoniae UTIs (odds ratio [OR], 3.61, 95% confidence interval, Cl, 1.49-8.73; P=0.004). Moreover, T2DM patients with ESBL-E. coli UTIs had higher all-cause mortality (hazard ratio [HR], 4.09; 95%, 1.14-14.59) than those with K. pneumoniae UTIs. Conclusion: Serum CRP levels, blood NLR, and IL-8 urinary levels differentiate ESBL-E. coli from K. pneumoniae UTIs in T2DM.

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“…The majority of UTIs in elderly residents are lower UTIs without fever or other signs of systemic illness,32 33 while most studies on CRP and PCT in UTI focus on diagnostic values in upper UTI or focus on distinguishing upper and lower UTI. The only small study on distinguishing lower UTI (infection) from ASB (colonisation) in adults, shows a high negative predictive value for UTI of PCT levels at a cut-off of 0.25 ng/mL34, suggesting that low PCT levels can rule out UTI and contribute to reducing antibiotic use.…”

Section: Introductionmentioning

confidence: 99%

Sensitivity of point-of-care testing C reactive protein and procalcitonin to diagnose urinary tract infections in Dutch nursing homes: PROGRESS study protocol

et al. 2019

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IntroductionSuspected urinary tract infection (UTI) ranks among the most common reasons for antibiotic use in nursing homes. However, diagnosing UTI in this setting is challenging because UTI often presents with non-specific symptomatology. Moreover asymptomatic bacteriuria is common in elderly, which complicates attribution of causality to detection of bacteria in urine. These diagnostic challenges contribute to overuse of antibiotics and emergence of antimicrobial resistance in nursing homes. Given the diagnostic challenges, there is a need for point-of-care (POC) diagnostic tests to support clinical rules for diagnosing UTI. Procalcitonin (PCT) and C reactive protein (CRP) are inflammatory blood markers that have been proven useful to support diagnosis and monitoring of (bacterial) respiratory tract infections and sepsis. While limited studies suggest their usefulness in supporting UTI diagnosis, their utility has not been studied in elderly populations for this purpose.Methods and analysisIn a 24-month matched prospective study, ‘PROGRESS’ will assess and compare the sensitivity of rapid POC measurements of blood CRP and PCT levels to support clinical rules for diagnosing UTI in nursing home residents. The primary outcome measure is sensitivity of the POC tests to identify patients with true UTI based on the predefined definition, as derived from receiver operating curves.Ethics and disseminationThis study will be conducted in accordance with Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. The study protocol is approved by the Medical Ethical Committee of Amsterdam UMC location VUmc with reference number 2017.350 and National Central Committee on Research involving Human Subjects with reference number NL62067.029.17.Trial registration numberNTR6467.

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Utility of initial procalcitonin values to predict urinary tract infection

Cited by 34 publications

References 34 publications

Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly

Evidence-Informed Practice: Diagnostic Questions in Urinary Tract Infections in the Elderly

<p>Blood Neutrophil-to-Lymphocyte Ratio and Urine IL-8 Levels Predict the Type of Bacterial Urinary Tract Infection in Type 2 Diabetes Mellitus Patients</p>

Sensitivity of point-of-care testing C reactive protein and procalcitonin to diagnose urinary tract infections in Dutch nursing homes: PROGRESS study protocol

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