Procalcitonin at 12–36 hours of fever for prediction of invasive bacterial infections in hospitalized febrile neonates

Abstract

AimWe aimed to investigate the performance of procalcitonin (PCT) assay between 12 and 36 h after onset of fever (PCT H12-H36) to predict invasive bacterial infection (IBI) (ie, meningitis and/or bacteremia) in febrile neonates.MethodsWe retrospectively included all febrile neonates hospitalized in the general pediatric department in a teaching hospital from January 2013 to December 2019. PCT assay ≤ 0.6 ng/ml was defined as negative. The primary outcome was to study the performance of PCT H12-H36 to predict IBI.ResultsOut of 385 included neonates, IBI was ascertainable for 357 neonates (92.7%). We found 16 IBI: 3 meningitis and 13 bacteremia. Sensitivity and specificity of PCT H12-H36 in the identification of IBI were, respectively, 100% [95% CI 82.9–100%] and 71.8% [95% CI 66.8–76.6%], with positive and negative predictive values of 14.3% [95% CI 8.4–22.2%] and 100% [95% CI 98.8–100%] respectively. Of the 259 neonates who had a PCT assay within the first 12 h of fever (< H12) and a PCT assay after H12-H36, 8 had IBI. Two of these 8 neonates had a negative < H12 PCT but a positive H12-H36 PCT.ConclusionsPCT H12-H36 did not miss any IBI whereas < H12 PCT could missed IBI diagnoses. PCT H12-H36 might be included in clinical decision rule to help physicians to stop early antibiotics in febrile neonates.

Febrile infants risk score at triage (FIRST) for the early identification of serious bacterial infections

“…Procalcitonin has been widely reported to be useful in this population and has been included in risk stratification algorithms 1 , 4 . Procalcitonin has been reported as an early marker of infection, and elevated levels between 12 and 36 h of fever suggest the presence of an IBI in hospitalized febrile neonates 26 . Our data-driven risk scores provided threshold cutoffs at 0.05, 0.36 and 4.38 (Table 2 ).…”

“…Our data-driven risk scores provided threshold cutoffs at 0.05, 0.36 and 4.38 (Table 2 ). Adding procalcitonin to a febrile infant clinical pathway resulted in decreased lumbar puncture for infants with at low risk of SBI 26 . However, more infants were assigned high risk and underwent laboratory investigations, resulting in no net change in overall resource utilization.…”