Procalcitonin Accurately Identifies Hospitalized Children With Low Risk of Bacterial Community-Acquired Pneumonia.
BACKGROUND
Lower procalcitonin (PCT) concentrations are associated with reduced risk of bacterial community-acquired pneumonia (CAP) in adults, but data in children are limited.


METHODS
We analyzed serum PCT concentrations from children hospitalized with radiographically confirmed CAP enrolled in the Centers for Disease Control and Prevention's Etiology of Pneumonia in the Community (EPIC) Study. Blood and respiratory specimens were tested using multiple pathogen detection methods for typical bacteria (eg, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus), atypical bacteria (Mycoplasma pneumoniae and Chlamydophila pneumoniae), and respiratory viruses. Multivariable regression was used to assess associations between PCT concentrations and etiology and severity.


RESULTS
Among 532 children (median age, 2.4 years; interquartile range [IQR], 1.0-6.3), patients with typical bacteria had higher PCT concentrations (±viruses; n = 54; median, 6.10; IQR, 0.84-22.79 ng/mL) than those with atypical bacteria (±viruses; n = 82; median, 0.10; IQR, 0.06-0.39 ng/mL), viral pathogens only (n = 349; median, 0.33; IQR, 0.12-1.35 ng/mL), or no pathogen detected (n = 47; median, 0.44; IQR, 0.10-1.83 ng/mL) (P < .001 for all). No child with PCT <0.1 ng/mL had typical bacteria detected. Procalcitonin <0.25 ng/mL featured a 96% negative predictive value (95% confidence interval [CI], 93-99), 85% sensitivity (95% CI, 76-95), and 45% specificity (95% CI, 40-50) in identifying children without typical bacterial CAP.


CONCLUSIONS
Lower PCT concentrations in children hospitalized with CAP were associated with a reduced risk of typical bacterial detection and may help identify children who would not benefit from antibiotic treatment.
University of Utah School of Medicine, Salt Lake City.
Chris
C
Stockmann
University of Utah School of Medicine, Salt Lake City.
Krow
K
Ampofo
University of Utah School of Medicine, Salt Lake City.
Jarrett
J
Killpack
Vanderbilt University School of Medicine, Nashville, Tennesse.
Derek J
DJ
Williams
Vanderbilt University School of Medicine, Nashville, Tennesse.
Kathryn M
KM
Edwards
Vanderbilt University School of Medicine, Nashville, Tennesse.
Carlos G
CG
Grijalva
University of Tennessee Health Science Center, Memphis.
Sandra R
SR
Arnold
University of Tennessee Health Science Center, Memphis.
Jonathan A
JA
McCullers
Emory University School of Medicine, Atlanta, Georgia.
Evan J
EJ
Anderson
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Richard G
RG
Wunderink
Vanderbilt University School of Medicine, Nashville, Tennesse.
Wesley H
WH
Self
Centers for Disease Control and Prevention, Atlanta, Georgia.
Anna
A
Bramley
Centers for Disease Control and Prevention, Atlanta, Georgia.
Seema
S
Jain
University of Utah School of Medicine, Salt Lake City.
Andrew T
AT
Pavia
University of Utah School of Medicine, Salt Lake City.
Anne J
AJ
Blaschke
D002116:Calcitonin / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000097:blood / Q000382:microbiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000209:etiology / Q000382:microbiology; D011237:Predictive Value of Tests; D012307:Risk Factors
D002116:Calcitonin