Use of Procalcitonin Assays to Predict Serious Bacterial Infection in Young Febrile Infants

Milcent, Karen; Faesch, S.; Guen, C. Gras-Le; Dubos, François; Poulalhon, Claire; Badier, I.; Marc, Elisabeth; Laguille, Christine; Pontual, Loïc de; Mosca, Alexis; Nissack, Gisèle; Biscardi, Sandra; Hors, H. Le; Louillet, Férielle; Dumitrescu, Andreea Madalina; Babe, Philippe; Vauloup‐Fellous, Christelle; Bouyer, Jean; Gajdos, Vincent

doi:10.1001/jamapediatrics.2015.3210

Cited by 189 publications

(180 citation statements)

References 40 publications

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“…29 However, we do know that the youngest infants with fever are infrequently pretreated with antibiotics. 16,18 Sixth, EV PCR testing decisions were at the discretion of the clinical team. Although we adjusted for patient age and study year, and clustering by center, we cannot fully control for clinical differences between tested and untested infants, raising the potential for unadjusted confounding.…”

Section: Discussionmentioning

confidence: 99%

“…We defined an invasive bacterial infection as growth of pathogenic bacteria from blood or CSF culture. Serious bacterial infection (SBI) was defined by the presence of any invasive bacterial infection or a urinary tract infection (UTI) 16 defined as a catheterized urine culture with ≥50,000 colony-forming units (CFUs)/mL of a single pathogenic bacteria or 10,000–50,000 CFUs/mL of a single pathogenic bacteria with an abnormal urinalysis (i.e., positive nitrite or leukocyte esterase test on urine dipstick or >5 WBCs/hpf on urine microscopy). 17,18 Cultures from which more than 1 bacterial species were isolated were considered contaminated unless 1 or more was a true pathogen.…”

Section: Methodsmentioning

confidence: 99%

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Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

Aronson

Lyons

Cruz

et al. 2017

The Journal of Pediatrics

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Objective To determine the impact of a cerebrospinal fluid (CSF) enteroviral polymerase chain reaction (PCR) test performance on hospital length of stay (LOS) in a large multicenter cohort of infants undergoing evaluation for central nervous system infection. Study design We performed a planned secondary analysis of a retrospective cohort of hospitalized infants ≤60 days of age who had a CSF culture obtained at one of 18 participating centers (2005–2013). After adjustment for patient age and study year as well as clustering by hospital center, we compared LOS for infants who had an EV PCR test performed vs. not performed and among those tested, for infants with a positive vs negative test result. Results Of 19,953 hospitalized infants, 4,444 (22.3%) had an EV PCR test performed and 945 (21.3% of tested infants) had positive test results. Hospital LOS was similar for infants who had an EV PCR test performed compared with infants who did not (Incident rate ratio [IRR] 0.98 hours; 95% CI: 0.89–1.06 hours). However, EV PCR-positive infants had a 38% shorter LOS than EV PCR-negative infants (IRR 0.62 hours; 95% CI: 0.57–0.68). No infant with a positive EV PCR test had bacterial meningitis (0%; 95% CI: 0–0.4%). Conclusions While EV PCR testing was not associated with a reduction in LOS, infants with a positive EV PCR test had a one-third shorter LOS compared with infants with a negative EV PCR test. Focused EV PCR test use could increase the impact on LOS for infants undergoing CSF evaluation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

Aronson

Lyons

Cruz

et al. 2017

The Journal of Pediatrics

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“…However, CRP has consistently demonstrated higher specificity than WBC count for SBI and IBI, often at the expense of a lower sensitivity. 29–34 While Milcent et al reported the highest sensitivity of 77% (95% CI: 66–86) for detection of SBI with a cutoff value of 20 mg/L, 33 this sensitivity is still low for detection of bacterial infection.…”

Section: Are There New Diagnostic Tools That Can Be Incorporated Intomentioning

confidence: 99%

Management of the Febrile Young Infant

Woll

Neuman

Aronson³

2017

Pediatr Emer Care

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Infants ≤90 days of age with fever are frequently evaluated in the pediatric emergency department. Physical exam findings and individual laboratory investigations are not reliable to differentiate benign viral infections from serious bacterial infections in febrile infants. Clinical prediction models were developed over 25 years ago and have high sensitivity but relatively low specificity to identify bacterial infections in febrile infants. Newer laboratory investigations such as C-reactive protein (CRP) and procalcitonin (PCT) have favorable test characteristics compared to traditional laboratory studies such as a white blood cell count. These novel biomarkers have not gained widespread acceptance due to lack of robust prospectively collected data, varying thresholds to define positivity, and differing inclusion criteria across studies. However, CRP and PCT, when combined with other patient characteristics in the Step-by-Step approach have a high sensitivity for detection of serious bacterial infection. RNA biosignatures are a novel biomarker under investigation for detection of bacterial infection in febrile infants.

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“…More recently, in the largest trial of its kind, Milcent et al 10 recruited over 2000 febrile infants less than 3 months of age presenting to the emergency department. They report an NLR of 0.1 for bacteraemia and bacterial meningitis in infants with a PCT of <0.3 ng/mL, demonstrating that a negative PCT markedly reduced the post-test probability of an IBI in a well-looking febrile infant.…”

Section: Indications and Limitationsmentioning

confidence: 99%

“…When compared with conventional markers of bacterial infection (CRP and neutrophils) in infants, PCT has better sensitivity and specificity for invasive infection (ie, bacteraemia and meningitis) than less invasive infections such as UTI and pneumonia 10. Milcent et al report that febrile infants with a raised PCT (>0.3 ng/mL) have a positive likelihood ratio of 4, suggesting that the likelihood of an IBI in such an infant is moderately raised 10. Furthermore, they report a sensitivity of a raised PCT level (>0.3 ng/mL) of 90%; for every 10 febrile infants with confirmed IBI, PCT alone would have correctly identified 9.…”

Section: Indications and Limitationsmentioning

confidence: 99%

How to use… Procalcitonin

Robinson

2018

Arch Dis Child Educ Pract Ed

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Diagnosing bacterial infection in the unwell or febrile child is a common challenge faced by all paediatricians. Despite the advent of novel molecular techniques, there is ongoing need for diagnostic assays with adequate performance and turnaround time to facilitate safe clinical decision-making when bacterial sepsis is suspected, such as whether to commence empirical treatment with antibiotics. Procalcitonin is an established marker of infection that has a potential role in the diagnosis and exclusion of serious or invasive bacterial infection in neonates and children. Although enthusiastically adopted in many countries and institutions, national guidance in the UK does not yet support its routine use. This article reviews the relevant literature on the use of procalcitonin measurement in common paediatric clinical scenarios.

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Use of Procalcitonin Assays to Predict Serious Bacterial Infection in Young Febrile Infants

Cited by 189 publications

References 40 publications

Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

Impact of Enteroviral Polymerase Chain Reaction Testing on Length of Stay for Infants 60 Days Old or Younger

Management of the Febrile Young Infant

How to use… Procalcitonin

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