Reduced utility of early procalcitonin and blood culture determination in patients with febrile urinary tract infections in the emergency department

To investigate the prognostic role of procalcitonin (PCT) assessment and blood culture (BC) acquisition in the emergency\r\ndepartment (ED) in patients with urinary tract infection (UTI) or urosepsis. We enrolled patients admitted for UTI to our\r\nED over a 10-year period. Mortality and in hospital length of stay (LOS) were compared between patients with UTI or\r\nurosepsis who had sampling for PCT levels and BC taken in the ED (ePCT group–eBC group) and those who had not (noePCT\r\ngroup–no-eBC group). 1029 patients were analyzed, 52.7% of which were female. Median age was 77 [65–83]; 139\r\npatients (13.5%) had complicated UTI. Median LOS was 10 [7–17] days. In the ePCT group, LOS was 10 [7–16] days, vs.\r\n10 [7–17] (p = 0.428) in the no-ePCT group. In the eBC group, LOS was 10 [6–16] days vs. 10 [7–17] days (p = 0.369) in the\r\nno-eBC group. The overall mortality rate was 6.6%. The mortality rate was not affected by early PCT determination (6% in\r\nthe ePCT group vs. 6.9% in the no-ePCT group, p = 0.584). Similarly, the mortality rate was not different in the eBC group\r\nas compared to the no-eBC group (5.4% vs. 6.9%, p = 0.415). Performance of ePCT or eBC testing made no significant difference\r\nin terms of improvement of mortality rates in septic patients (11.4% vs. 7.2%; p = 0.397 and 8.8% vs. 9.8%; p = 0.845,\r\nrespectively). The prognostic relevance of early evaluation of PCT and BC in the ED of patients with febrile UTI appears\r\nlimited. In complicated UTI patients, PCT and BC testing may be more appropriate in the context of improving antibiotic\r\nstewardship, or as an integral component of PCT-guided standardized protocols.