[Procalcitonin and viral meningitis: reduction of unnecessary antibiotics by measurement during an outbreak].
OBJECTIVE
Viral meningitis are often treated with antibiotics in emergency because routine analysis of CSF is not always efficient for distinguishing between viral and bacterial infection. The aim of the study was to evaluate the usefulness of procalcitonin (PCT) to reduce antibiotic treatments.


RESULTS
A blood PCT level < 0.5 ng/mL was prospectively used for the diagnosis of viral origin of meningitis in 58 patients (two months-14 years), in which enterovirus was isolated by culture or PCR during an outbreak (May-June 2000). CSF cells range was 10 to 2800/mL (m: 244), PMN 5 to 2464/mL and CSF proteins range was 0.19 to 0.92 mg/dL (m: 0.37). Seventeen patients received antibiotic therapy in admission. In nine patients, PCT (dosage was routinely measured 3/week) result < 0.5 ng/mL was obtained in 24 h and in 48 h in six: treatment was then stopped and children led hospital. In two patients, PCT was > 1 ng/mL because of bacterial coinfection. CSF and PCT values were similar to those of an already published control group.


CONCLUSIONS
PCT dosage allowed to shorten hospitalization of 4.47 (controls) to 2.06 (patients) days in patients receiving unnecessary antibiotic treatments. During this outbreak, PCT dosage allowed to reduce 40 days of hospitalization.
Marc
E
E
Service de pédiatrie générale, hôpital Cochin-Saint-Vincent-de-Paul, service d'accueil des urgences, 82, avenue Denfert-Rochereau, 75674 Paris, France.
Ménager
C
C
Moulin
F
F
Stos
B
B
Chalumeau
M
M
Guérin
S
S
Lebon
P
P
Brunet
F
F
Raymond
J
J
Gendrel
D
D
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000134:cerebrospinal fluid*; D002116:Calcitonin / Q000134:cerebrospinal fluid*; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy; D008587:Meningitis, Viral / Q000175:diagnosis* / Q000188:drug therapy; D010347:Patient Care Planning; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D011498:Protein Precursors / Q000134:cerebrospinal fluid*
D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide