Usefulness of serum procalcitonin and point-of-care multiplex PCR gastro-intestinal panel in acute diarrhoea or colitis in the emergency department

Abstract

Introduction

Acute infectious diarrhoea is one of the most common diseases worldwide. Procalcitonin (PCT) is useful for antibiotic stewardship in lower respiratory tract infections but has been poorly studied in infectious diarrhoea. Our objective is to describe the PCT concentrations according to diarrhoea aetiology.

Methods

This is a single-center prospective cohort study involving adults consulting the emergency department (ED) for an acute diarrhoea or colitis. Serum PCT was measured and a stool sample was tested with FilmArray® Gastro-Intestinal Panel. The primary endpoint is the PCT concentration according to each type of pathogen identified using Gastro-Intestinal-panel and/or stool cultures at ED admission.

Results

125 patients were included: 80 had an acute infectious diarrhoea, 21 an acute colitis and 24 another illness causing diarrhoea. The median (interquartile ranges) PCT values (ng/ml) were 0.13 (0.08-0.28), 0.07 (0.06-0.54), 0.13 (0.09-0.26) and 0.05 (0.03-0.17), respectively if there was a bacteria (n = 41), parasite (n = 3), virus (n = 10) or no pathogen identified and 0.34 (0.13-1.03) if the diarrhoea was due to another illness (n = 24).

Conclusion

In patients admitted to the ED with an acute infectious diarrhoea or acute colitis, PCT remained low when a bacteria was identified. It may not be informative in current practice to guide antibiotic therapy.

Keywords:

• Acute diarrhoea
• acute colitis
• procalcitonin
• multiplex PCR
• emergency department

Acknowledgments

To bioMerieux by providing, free of charge, Filmarray® and GI panel cartridges and Torch. To Laura Wakselman for helping with reglementary procedures and submission of the protocol to the ethics committee.

Author contributions

Conception and design: MCA, PH, AD; Acquisition of data: MCA, CC, IC, EF; Analysis: MCA; Interpretation of data: MCA, PH; Drafting the article: MCA; Revising it critically for important intellectual content: MCA, AD, PH; Final approval of the version to be published: MCA, CC, AD, PH

Disclosure statement

• MCA was invited to a congress by Biomerieux

• PH received educational support and congress communication fees from ThermoFisher Scientific, Radiometer and bioMérieux.

All other authors have no potential conflict of interest.

Filmarray® and GI panel cartridges were provided free of charge by bioMérieux, Marcy l’Etoile, France.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.