Procalcitonin good marker of bacteremia in children with central lines

By Helen Albert, Senior medwireNews Reporter

High procalcitonin (PCT) levels are a good indicator of bacteremia in children with a central venous catheter who present to the emergency department with fever, suggest study findings.

The researchers suggest that using PCT levels as an initial test on admission to hospital may help children with central lines who do not have bacteremia from being exposed to antibiotics unnecessarily.

Children with central lines are at high risk for bloodstream infections and are likely to be immunocompromised, at least to a certain degree, making them also more susceptible to viral infections.

PCT levels are normally low in the bloodstream, but are known to rise in response to bacterial endotoxin exposure.

To test the validity of PCT as a marker of bacterial infection in children with central lines, Amanda Kasem (Phoenix Children's Hospital, Arizona, USA) and colleagues recruited 62 patients between the age of 5 months and 18 years who had central lines and were admitted to hospital with fever.

Overall, 14 (23%) of these children had a positive culture for bacterial infection. The level of PCT in the blood of these children was significantly higher than in the blood of those who did not have bacteremia, at a mean of 18.47 versus 0.65 ng/mL.

The team found that the median PCT level for a negative blood culture was 0.23 ng/mL and 1.15 ng/mL for a positive culture. Receiver operating characteristic analysis showed that 0.3 ng/mL PCT was the best cutoff point for identifying bacterial blood infection, with a sensitivity of 93%, a specificity of 63%, and an area under the curve score of 0.82.

"Further studies would need to be performed to determine whether serial PCT values may be of use in guiding further in-patient management and the continued need for intravenous antibiotic therapy," write Kasem et al in Pediatric Emergency Care.

"PCT levels are unlikely to influence the initiation of antibiotics in children with febrile neutropenia, but PCT-guided decision making could potentially shorten length of stay of admitted patients, specifically the subset of patients with negative blood cultures, thereby decreasing costs," they suggest.

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