title: [Serum procalcitonin: a reliable tool for the diagnosis and follow-up of neonatal bacterial infections in Sub-Saharan Africa].
abstract: OBJECTIVE
  Neonatal infection (NNI) is a public health problem in developing countries where pediatricians and specifically neonatologists encounter many diagnostic difficulties. Having a precise and easily measurable biological marker, with a high sensitivity and a high negative predictive value, that can rapidly detect NNI, remains a great challenge. The aim of this study was to determine the place of serum procalcitonin (PCT) in the diagnosis and follow-up of bacterial NNI in resource-limited contexts.
  
  
  METHODS
  We carried out a cross-sectional study from October 2009 to February 2010 at the Mother and Child Centre of the Chantal Biya Foundation, Cameroon. We included all neonates born at term, suspected of NNI, and hospitalized in the Neonatal Care Unit of the aforementioned centre during the study period. We measured PCT levels at entry and 48h later, and determined its sensitivity, specificity, and positive and negative predictive values.
  
  
  RESULTS
  Twenty-five out of the 98 neonates enrolled presented with a confirmed diagnosis of NNI. PCT was positive in 92.4% of cases. Contrariwise, serum C-reactive protein was positive in 84.6% of patients with a cut-off point at 6mg/L, and remained positive in only 38.4% of cases when the cut-off point was raised to 20mg/L. The sensitivity, specificity, and positive and negative predictive values of PCT were 96.0%, 77.7%, 85.3%, and 93.3%, respectively. Six deaths were recorded, five of which exhibited very high PCT levels (≥10ng/mL). All neonates with negative PCT levels had a good clinical outcome as none of them died. If PCT were to be considered as a diagnostic tool of NNI, only 43 (43.9%) neonates would have benefited from a justified antibiotic therapy exceeding 48h, with a significant reduction in duration of hospitalization (9.1±3.3 vs 5.1±4.6 days; P<0.05).
  
  
  CONCLUSIONS
  PCT may be an early and reliable indicator of bacterial NNI. Its course throughout hospitalization may reflect the therapeutic response, and elevated levels of PCT may be highly suggestive of a poor clinical prognosis. PCT could therefore serve as a useful tool for the screening, diagnosis, and follow-up of neonates suspected of bacterial NNI in resource-poor settings.
authors.affiliation: Unité de prise en charge de la drépanocytose, centre mère et enfant, fondation Chantal-Biya, BP : 25121, Yaoundé, Cameroun; Faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun. Electronic address: anica_2001@yahoo.fr.
authors.forename: A N
authors.initials: AN
authors.lastname: Alima Yanda
authors.affiliation: Faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Programme élargi de vaccination, ministère de la Santé publique, Yaoundé, Cameroun.
authors.forename: M
authors.initials: M
authors.lastname: Kobela
authors.affiliation: Unité de prise en charge de la drépanocytose, centre mère et enfant, fondation Chantal-Biya, BP : 25121, Yaoundé, Cameroun; Faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun.
authors.forename: J R
authors.initials: JR
authors.lastname: Nansseu
authors.affiliation: Unité de prise en charge de la drépanocytose, centre mère et enfant, fondation Chantal-Biya, BP : 25121, Yaoundé, Cameroun; Faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun.
authors.forename: J
authors.initials: J
authors.lastname: Taguebue
authors.affiliation: Unité de prise en charge de la drépanocytose, centre mère et enfant, fondation Chantal-Biya, BP : 25121, Yaoundé, Cameroun.
authors.forename: A
authors.initials: A
authors.lastname: Boula
authors.affiliation: Hôpital Laquintinie de Douala, Douala, Cameroun.
authors.forename: C
authors.initials: C
authors.lastname: Eposse
authors.affiliation: Unité de prise en charge de la drépanocytose, centre mère et enfant, fondation Chantal-Biya, BP : 25121, Yaoundé, Cameroun; Faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun.
authors.forename: N
authors.initials: N
authors.lastname: Monono
authors.affiliation: Unité de prise en charge de la drépanocytose, centre mère et enfant, fondation Chantal-Biya, BP : 25121, Yaoundé, Cameroun; Faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun.
authors.forename: S
authors.initials: S
authors.lastname: Ngo Um-Sap
authors.affiliation: Hôpitaux universitaires de Genève, Genève, Suisse.
authors.forename: A
authors.initials: A
authors.lastname: Gervaix
authors.affiliation: Unité de prise en charge de la drépanocytose, centre mère et enfant, fondation Chantal-Biya, BP : 25121, Yaoundé, Cameroun; Faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun.
authors.forename: P O
authors.initials: PO
authors.lastname: Koki Ndombo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002163:Cameroon; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide