JCM Accepts, published online ahead of print on 21 October 2009

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J. Clin. Microbiol. doi:10.1128/JCM.00628-09
Copyright (c) 2009, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

CD64 Index Provides Simple and Predictive Testing for the Detection and Monitoring of Sepsis and Bacterial Infection in Hospital Patients

M Icardi^*, Y Erickson, S Kilborn, B Stewart, B Grief, and G Scharnweber

Department of Pathology, Iowa City Veterans Hospital, 601 Highway 6 West, Iowa City IA 52246; University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52245

^* To whom correspondence should be addressed. Email: michael-icardi{at}uiowa.edu.

The rapid diagnosis and management of bacterial infection is heavily dependent upon clinical assessment. Blood culture may take up to 2 days for results and may be suspect. Surface neutrophil CD64 expression has been shown to be upregulated in cases of bacterial infection. Recently, a standardized kit for CD64 index was used in neonatal intensive care units showing high sensitivity and specificity for bacterial infections. Our study was designed to confirm and extend these results to adult hospital patients and to determine the impact of this testing on a clinical laboratory's finances and staffing. CD64 indices were performed on peripheral blood drawn in tandem with blood cultures from 109 patients over a 2 month period. We found that a CD64 index of <= 1.19 was predictive of "no growth" blood culture results. An index of >1.19 was predictive of an ultimate clinical and/or culture diagnosis of infection with a sensitivity and specificity of 94.6% and 88.7%. Positive and negative predictive values were 89.8% and 94%. The CD64 index was easily performed using our flow cytometer and staff, producing minimal alteration in clinical workflow. A 7 day a week testing schedule will result in some additional expense, but will be more than offset by the expected cost savings. The CD64 index is a useful and inexpensive test for improving the diagnosis and management of hospital patients with bacterial infection. It can be readily performed by clinical laboratories and could result in considerable savings for the institution