Is ATLAS score for Clostridium difficile Infection useful in

predicting response to therapy?

Mihaela Lupse, Mihai Aronel Rus, Mirela Flonta, Celina Cancel, Violeta Siladi, Andreea Stefania Asiminoaiei, Anca Lupu,
Madalina Tuns, Nicolae Todor
University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Romania

Background Results
During the study period there were 506 patients
During the last decades Clostridium difficile with CDI, 276 women (54.5%), with average age
infection (CDI) became a serious threat in the 65.6 (min 18, max 97, median 68 years). 1 1
hospital wards and now it’s one of the leading 0.9 0.9
causes of nosocomial infections. One of the 497 patients (98%) were treated with
0.8 0.8
most useful bedside severity scoring systems for metronidazole, vancomycin or both.
0.7 0.7
CDI is the ATLAS score that has recently been There were 261 patients (52%) with score 0-2, 0.6 0.6
ATLAS score for treatment with Metro,
published by Miller and coworkers in BMC 212 (42%) with score 3-6 and 33 patients (6%) 0.5 ATLAS score for Metro
(n=165, p=0.28, cut off <2)
0.5
Vanco (n=36, p<0.01, cut off >4)
Infectious Diseases 2013. Using the data from with score 7-10. From 165 patients treated with 0.4 Se=67%, Sp=58% 0.4 Se=100%, Sp=85%

two trials of CDI he could not validate his score metronidazole: 108 had mild disease, 55 had 0.3 0.3

for treatment moderate disease and 2 had severe disease. 0.2 0.2

0.1 0.1
Between 102 patients treated with vancomycin:
0 0
51 were mild, 40 were moderate and 11 were
Objective severe. Associated treatment with metronidazole
0 0.2 0.4 0.6 0.8 1 0 0.2 0.4 0.6 0.8 1

and vancomycin was used in 194 patients: 79

The aim of our study was to evaluate the
with mild, 97 with moderate and 18 with severe
usefulness of the ATLAS score in predicting the 1 1
disease.
response to the most used antibiotics for CDI 0.9 0.9
treatment: vancomycin, metronidazole or both. 42 patients (8.3%) died during hospitalization. 0.8 0.8
0.7 0.7
The fatality rate was 2.7% for mild disease,
0.6 0.6
11.8% for moderate disease and 30.3% for ATLAS score for treatment with ATLAS score for treatment with
0.5 0.5
Materials & Methods severe disease. 0.4
Vanco(n=102, p<0.01, cut off >4)
Se=69%, Sp=88% 0.4
Vanco+Metro (n=194, p<0.01, cutoff >3)
Se=65%, Sp=60%

We obtained a low sensitivity and specificity with 0.3 0.3

We performed a retrospective 30 months 0.2
both chi square test and ROC curves for 0.2
observational study (Nov 2012 - Apr 2015) 0.1 0.1
metronidazole treatment at any score value, a
evaluating all adult patients admitted in The 0 0
good specificity for vancomycin for score more 0 0.2 0.4 0.6 0.8 1 0 0.2 0.4 0.6 0.8 1
University Hospital of Infectious Diseases from
than 4 and for metronidazole plus vancomycin
Cluj-Napoca Romania for the first episode of CDI
for score more than 2 with both tests.
or who developed Clostridium difficile diarrhea
during hospitalization. To confirm the diagnosis ATLAS score
Conclusions References
there were used GDH test and toxin assay 0-2 3-6 >6 1. P452. Mark A Miller ATLAS-A Bedside Scoring System –
(VIDAS bioMerieux). We used ATLAS score as it Treatment Death Alive Death Alive Death Alive Total 1) ATLAS score could be used for stratification Predicting Mortality Due to Clostridium Difficile Infection
was presented by Mark Miller at IDSA 2010 (age, 2 106 54 2 of disease severity. (CDI) in Elderly Hospitalized Patients. 48th IDSA Annual
Metro 1 (0.6%) 165 Meeting 2010
temperature, leukocytosis, albumin, systemic (1.2%) (64.2%) (32.7%) (1.2%)
concomitant antibiotics during CDI treatment). 2) ATLAS score has a good predictive value for 2. Miller M, Louie T, Mullane K, Weiss K, Lentnek A, Golan
2 49 6 34 5 6 Y, Kean Y, Sears P. Derivation and validation of a simple clinical
Score values 0-2 were associated with mild, 3-6
Vanco
(2%) (48%) (5.9%) (33.3%) (4.9%) (5.9%)
102 antibiotic treatment only for severe infection
bedside score (ATLAS) for Clostridium difficile infection which
with moderate and 7-10 with severe disease. We but not for mild and moderate infection
19 1 14 1 1 predicts response to therapy. BMC Infectious Diseases 2013;
compared the outcome during CDI treatment for
Metro, Vanco
(52.8%) (2.8%) (38.9%) (2.8%) (2.8%)
36 according with treatment guidelines. 13:148 DOI: 10.1186/1471-2334-13-148
3. Raúl Hernández-Garcíaa, Elvira Garza-Gonzálezb, Mark
different severity of the disease according with Vanco+Metro
3 76 16 81 4 14
194
3) Physicians are more likely to use
(1.5%) (39.2%) (8.2%) (41.8%) (2.1%) (7.2%)
Millerc, Giovanna Arteaga-Mullerd, Alejandra María Galván-de
ATLAS score. We used for statistical analysis vancomycin alone in severe cases than the los Santosa, Adrián Camacho-Ortiz Application of the ATLAS
Chi square test and ROC curves. 7 250 24 183 10 23
497 association between vancomycin and score for evaluating the severity of Clostridium difficile
(1.4%) (50.3%) (4.8%) (36.8%) (2%) (4.6%) infection in teaching hospitals in Mexico. The Brazilian Journal
metronidazole.
of Infectious Diseases.2015. vol 19(4):399–402

mihaela.lupse@yahoo.com