Is Procalcitonin Useful in Pediatric Critical Care Patients?

Pérez, Sandra Martínez; Rodríguez-Fanjul, Javier; Jordan, Iolanda

doi:10.1177/1177271918792244

Cited by 18 publications

(14 citation statements)

References 110 publications

(119 reference statements)

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“…Much like for adults, sepsis is one of the most researched conditions for the use of PCT-guided antibiotic therapy in children. Other potential diseases include bacterial infection [ 135 ], where a recent review reported reduced antibiotic exposure and length of ICU stay [ 136 ], as well as bronchiolitis [ 137 ] and meningitis [ 107 ], all of which showed promising results.…”

Section: Department Of Pediatricsmentioning

confidence: 99%

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

Wolfisberg

Gregoriano

Schuetz

2021

Critical Reviews in Clinical Laboratory Sciences

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Procalcitonin (PCT) is useful for differentiating between viral and bacterial infections and for reducing the unnecessary use of antibiotics. As the rise of antimicrobial resistance reaches “alarming” levels according to the World Health Organization, the importance of using biomarkers, such as PCT to limit unnecessary antibiotic exposure has further increased. Randomized trials in patients with respiratory tract infections have shown that PCT has prognostic implications and its use, embedded in stewardship protocols, leads to reductions in the use of antibiotics in different clinical settings without compromising clinical outcomes. However, available data are heterogeneous and recent trials found no significant benefit. Still, from these trials, we have learned several key considerations for the optimal use of PCT, which depend on the clinical setting, severity of presentation, and pretest probability for bacterial infection. For patients with respiratory infections and sepsis, PCT can be used to determine whether to initiate antimicrobial therapy in low-risk settings and, together with clinical data, whether to discontinue antimicrobial therapy in certain high-risk settings. There is also increasing evidence regarding PCT-guided therapy in patients with coronavirus disease 2019 (COVID-19). This review provides an up-to-date overview of the use of PCT in different clinical settings and diseases, including a discussion about its potential to improve the care of patients with COVID-19.

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Section: Department Of Pediatricsmentioning

confidence: 99%

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

Wolfisberg

Gregoriano

Schuetz

2021

Critical Reviews in Clinical Laboratory Sciences

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“…Its early response to an active infection and its rapid drop when the infection is controlled help clinicians to stop or curtail antibiotic therapy. Its use is widely recognised in infants with fever of unknown origin [11][12][13], as it is a more accurate biomarker than traditional screening tests [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Use of procalcitonin and C-reactive protein in the diagnosis of bacterial infection in infants with severe bronchiolitis

et al. 2020

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The objective was to evaluate the use of procalcitonin (PCT) and C-reactive protein (CRP) for the diagnosis of bacterial infection in bronchiolitis patients. A prospective, single-centre, descriptive, and comparative observational study was carried out on patients with severe bronchiolitis admitted to the paediatric intensive care unit (PICU), from January 2011 to July 2017. Two cohorts were compared: patients with invasive bacterial infection (IBI) and patients with no bacterial infection (NBI). We included 675 patients, 399 of whom were males (59.1%), with median age of 47 days (IQR 25-100.3). Of them, 181 patients were diagnosed with IBI (26.8%). Seventytwo had sepsis (10.7%), 106 had pneumonia (15.7%), and 41 had a urinary tract infection (6.1%). PCT and CRP values were significantly higher in patients with IBI. ROC curves compared the ability of PCT and CRP to diagnose IBI at admission, 24 h, and 48 h. PCT showed a better AUC for diagnosing IBI, with statistically significant differences at all time points (p < 0.001). The best PCT cut-off for IBI diagnosis at admission was 1.4 ng/mL, with a sensitivity of 69% (95% CI 58.4-74.9) and a specificity of 91% (95% CI 88.1-92.5). Procalcitonin showed a better AUC for diagnosing both sepsis and pneumonia, which makes it an excellent predictor. Conclusion:We present PCT as a novel test in comparison with the traditional CRP screening test to discern which bronchiolitis patients have IBI. We highlight the importance of PCT for the diagnosis of pneumonia and sepsis, as it proved to be more sensitive and specific than CRP, with statistically significant differences. What is Known:• Bronchiolitis should be treated with antibiotics only when a bacterial infection is present.• The rate of antibiotic prescription in severe bronchiolitis is extremely high, so diagnostic tools are needed. What is New:• PCT is a good biomarker to discern which bronchiolitis patients have IBI, specially for pneumonia and sepsis diagnoses. It is more sensitive and specific than CRP, with statistically significant differences. • Implementation of PCT cut-off values may prevent unnecessary antibiotic use.

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“…Recent studies underlined the promising utility of them as prognostic predictors in patients with heart failure or low cardiac output syndrome also in children [6–9]. PCT is known to be more specific and earlier than classical biomarkers in the diagnosis of infectious complications [10,11]. Although PCT may increase slightly in the systemic inflammatory response syndrome, as it occurs after CPB, most studies point to better predictive values of PCT than other clinical or analytical markers to discriminate the presence or absence of infection [6,12–14].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of biomarkers after cardiopulmonary bypass in pediatrics: The prospective PANCAP study

et al. 2019

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Objective To assess the usefulness of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide as predictors of need for mechanical ventilation and postoperative complications (need for inotropic support and bacterial infection) in critically ill pediatric patients after cardiopulmonary bypass. Design A prospective, observational study Setting Pediatric intensive care unit. Patients Patients under 18 years old admitted after cardiopulmonary bypass. Measuraments and main results Serum levels of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide were determined immediately after bypass and at 24–36 hours. Their values were correlated with the need for mechanical ventilation, inotropic support and bacterial infection. One hundred eleven patients were recruited. Septal defects (30.6%) and cardiac valve disease (17.1%) were the most frequent pathologies. 40.7% required mechanical ventilation, 94.6% inotropic support and 15.3% presented invasive bacterial infections. Pro-adrenomedullin and pro-atrial natriuretic peptide showed significant high values in patients needing mechanical ventilation. Cut-off values higher than 1.22 nmol/L and 215.3 pmol/L, respectively for each biomarker, may indicate need for mechanical ventilation with an AUC of 0.721 and 0.746 at admission and 0.738 and 0.753 at 24–36 hours, respectively but without statistical differences. Pro-adrenomedullin and procalcitonin showed statistically significant high values in patients with bacterial infections. Conclusions After bypass, pro-adrenomedullin and pro-atrial natriuretic peptide are suitable biomarkers to predict the need for mechanical ventilation. Physicians should be alert if the values of these markers are high so as not to progress to early extubation. Procalcitonin is useful for predicting bacterial infection. This is a preliminary study and more clinical studies should be done to confirm the value of pro-adrenomedullin and pro-atrial natriuretic peptide as biomarkers after cardiopulmonary bypass.

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Is Procalcitonin Useful in Pediatric Critical Care Patients?

Cited by 18 publications

References 110 publications

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

Use of procalcitonin and C-reactive protein in the diagnosis of bacterial infection in infants with severe bronchiolitis

Prognostic value of biomarkers after cardiopulmonary bypass in pediatrics: The prospective PANCAP study

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