Impact of procalcitonin on the management of children aged 1 to 36 months presenting with fever without source: a randomized controlled trial.
OBJECTIVE
The aim of the study was to evaluate the impact of procalcitonin (PCT) measurement on antibiotic use in children with fever without source.


METHODS
Children aged 1 to 36 months presenting to a pediatric emergency department (ED) with fever and no identified source of infection were eligible to be included in a randomized controlled trial. Patients were randomly assigned to 1 of 2 groups as follows: PCT+ (result revealed to the attending physician) and PCT- (result not revealed). Patients from both groups also had complete blood count, blood culture, urine analysis, and culture performed. Chest radiography or lumbar puncture could be performed if required.


RESULTS
Of the 384 children enrolled and equally randomized into the PCT+ and PCT- groups, 62 (16%) were diagnosed with a serious bacterial infection (urinary tract infection, pneumonia, occult bacteremia, or bacterial meningitis) by primary ED investigation. Ten were also found to be neutropenic (<500 x 10(6)/L). Of the remaining undiagnosed patients, 14 (9%) of 158 received antibiotics in the PCT+ group vs 16 (10%) of 154 in the PCT- group (Delta -2%; 95% confidence interval [CI], -8 to 5). A strategy to treat all patients with PCT of 0.5 ng/mL or greater with prophylactic antibiotic in this group of patients would have resulted in an increase in antibiotic use by 24% (95% CI, 15-33).


CONCLUSIONS
Semiquantitative PCT measurement had no impact on antibiotic use in children aged 1 to 36 months who presented with fever without source. However, a strategy to use prophylactic antibiotics in all patients with abnormal PCT results would have resulted in an increase use of antibiotics.
Manzano
Sergio
S
Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Quebec, Canada H3T 1C5.
Bailey
Benoit
B
Girodias
Jean-Bernard
JB
Galetto-Lacour
Annick
A
Cousineau
Jocelyne
J
Delvin
Edgard
E
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005335:Fever of Unknown Origin / Q000097:blood* / Q000209:etiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D015203:Reproducibility of Results; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide