title: Procalcitonin is useful in identifying bacteraemia among children with pneumonia.
abstract: Empirical antibiotic use is prescribed in managing children with pneumonia worldwide. We assessed the usefulness of procalcitonin (PCT) and interferon-alpha (IFN-alpha) in differentiating viral from bacterial pneumonia. Among 159 hospitalized children, pneumonia was diagnosed based on clinical complaints plus pulmonary infiltrate. Aetiology was investigated for 9 viruses and 4 atypical and 3 typical bacteria. PCT and IFN-alpha were measured in the serum sample collected on admission. Eight patients had bacteraemic infections, 38 had non-bacteraemic typical infections, and 19 patients had atypical bacterial infections. Viral and unknown aetiology was established in 57 (36%) and 34 (21%) cases, respectively. Three patients with bacterial infection without collected blood culture were excluded. IFN-alpha (IU/ml) was detectable in 20 (13%) cases. The difference among median PCT values of the bacteraemic (4.22; 1.56-7.56), non-bacteraemic typical bacterial (1.47; 0.24-4.07), atypical bacterial (0.18; 0.06-1.03) and only viral (0.65; 0.11-2.22) subgroups was significant (p = 0.02). PCT was > or =2 ng/ml in 52 (33%) cases. The presence of IFN-alpha was associated with PCT <2 ng/ml (90% vs. 64%, p = 0.02). The negative predictive value (95% confidence interval) of PCT > or =2 ng/ml was 95% (89-100%), 89% (78-100%), 93% (85-100%) for differentiation of bacteraemic from viral, atypical bacterial and non-bacteraemic typical bacterial infection, respectively, and 58% (49-68%) for differentiation between bacterial and viral infection. PCT may be useful in identifying bacteraemia among children hospitalized with community-acquired pneumonia. IFN-alpha was uncommonly detected.
authors.affiliation: Paediatrics Department, Federal University of Bahia School of Medicine, Salvador. nascimentocarvalho@hotmail.com
authors.forename: Cristiana M
authors.initials: CM
authors.lastname: Nascimento-Carvalho
authors.forename: Maria-Regina A
authors.initials: MR
authors.lastname: Cardoso
authors.forename: Aldina
authors.initials: A
authors.lastname: Barral
authors.forename: César A
authors.initials: CA
authors.lastname: Araújo-Neto
authors.forename: Sylvie
authors.initials: S
authors.lastname: Guerin
authors.forename: Annika
authors.initials: A
authors.lastname: Saukkoriipi
authors.forename: Mika
authors.initials: M
authors.lastname: Paldanius
authors.forename: Raija
authors.initials: R
authors.lastname: Vainionpää
authors.forename: Pierre
authors.initials: P
authors.lastname: Lebon
authors.forename: Maija
authors.initials: M
authors.lastname: Leinonen
authors.forename: Olli
authors.initials: O
authors.lastname: Ruuskanen
authors.forename: Dominique
authors.initials: D
authors.lastname: Gendrel
mesh_terms: D016470:Bacteremia / Q000097:blood / Q000175:diagnosis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis / Q000382:microbiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016898:Interferon-alpha / Q000097:blood; D008297:Male; D018410:Pneumonia, Bacterial / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D011024:Pneumonia, Viral / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric
chemical_list: C000606589:CALCA protein, human; D016898:Interferon-alpha; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide