title: Procalcitonin as a marker of bacteremia in children with fever and a central venous catheter presenting to the emergency department.
abstract: OBJECTIVE
  To evaluate the clinical use of procalcitonin (PCT) as a rapid marker for the identification of bacteremia in the emergency department (ED) population of children with fever and a central venous catheter (CVC).
  
  
  METHODS
  Children were identified on presentation to the ED with a chief complaint of fever and who had a CVC. Fever was defined as 38°C or higher orally. Patients were excluded from the study if they had received antibiotics within the previous 24 hours of presenting to the ED, if they had a peripherally inserted central catheter line or by parental refusal. On presentation to the ED, all patients had a complete blood cell count with differential, blood culture from the central line, and PCT levels drawn. All had empiric antibiotics initiated. Blood culture results were recorded, and in the case of positive cultures, time to positive culture was noted.
  
  
  RESULTS
  Sixty-two patients (aged 5 months-18 y) were enrolled, and 14 (23%) had a positive culture. Mean PCT value in bacteremic patients was 18.47 ± 31.6 ng/mL and 0.65 ± 1.2 ng/mL in nonbacteremic patients (P < 0.001). Median PCT for negative blood culture was 0.23 ng/mL (interquartile range, 0.11-0.61) and 1.15 ng/mL for a positive blood culture (interquartile range, 0.45-29.16). The receiver operating characteristic analysis identified a level of PCT of 0.3 ng/mL as the best cutoff point that produced a sensitivity of 93% and a specificity of 63% (area under the curve, 0.82).
  
  
  CONCLUSIONS
  The PCT levels are useful in identifying children with fever and a CVC who are bacteremic in the ED.
authors.affiliation: Department of Pediatric Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA. amandakasem@gmail.com
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Kasem
authors.forename: Blake
authors.initials: B
authors.lastname: Bulloch
authors.forename: Michael
authors.initials: M
authors.lastname: Henry
authors.forename: Kunal
authors.initials: K
authors.lastname: Shah
authors.forename: Heidi
authors.initials: H
authors.lastname: Dalton
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D062905:Central Venous Catheters / Q000009:adverse effects* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000097:blood* / Q000150:complications / Q000188:drug therapy; D005500:Follow-Up Studies; D006023:Glycoproteins; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide