近期免疫接种后发热婴儿的降钙素原水平。

Dauber Andrew, Weiss Scott, Maniaci Vincenzo, Nylen Eric, Becker Kenneth L, Bachur Richard

Divisions of Endocrinology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.

Pediatrics. 2008 Nov;122(5):e1119-22. doi: 10.1542/peds.2008-1884.

BACKGROUND

Procalcitonin has been identified as a useful blood marker of serious bacterial infection in febrile infants. Many infants present with a febrile reaction after receiving immunizations. The effects of immunization on procalcitonin have not been investigated.

METHODS

We performed a prospective observational cohort study at a large, urban pediatric emergency department. Infants <or=90 days of age with fever of >or=38 degrees C were enrolled. Subjects were divided into 3 groups: infants with serious bacterial infection; subjects without serious bacterial infection who received recent (<48 hours) immunizations; and subjects without serious bacterial infection who did not recently receive immunizations. Procalcitonin was measured by using a quantitative immunometric assay.

RESULTS

Over 13 months, procalcitonin was measured for 271 infants. There were 44 (16%) patients with serious bacterial infection, 35 in the recent-immunization group, and 192 in the no-recent-immunization group. The median procalcitonin level for serious bacterial infection was 0.53 ng/mL, for recent immunization was 0.29 ng/mL, and for no recent immunizations was 0.17 ng/mL. Procalcitonin values were elevated for patients with serious bacterial infection compared with patients both with and without recent immunizations. Compared with patients who had no recent immunizations, procalcitonin levels were elevated in patients with recent immunization. Using a cut point of 0.12 ng/mL, the sensitivity of procalcitonin for serious bacterial infection was 96%, specificity was 23%, and negative predictive value was 96%. Two patients with recent immunization who had serious bacterial infection were identified with this cut point.

CONCLUSIONS

Among febrile infants with recent immunization, procalcitonin levels are increased compared with patients with fever and no identified bacterial infection. Despite this increase, procalcitonin can still reliably discriminate infants with serious bacterial infection.

背景

降钙素原已被确认为发热婴儿严重细菌感染的一种有用的血液标志物。许多婴儿在接种疫苗后会出现发热反应。免疫接种对降钙素原的影响尚未得到研究。

方法

我们在一家大型城市儿科急诊科进行了一项前瞻性观察队列研究。纳入年龄≤90天、体温≥38摄氏度的发热婴儿。受试者分为3组：患有严重细菌感染的婴儿；近期（<48小时）接种过疫苗但无严重细菌感染的受试者；近期未接种过疫苗且无严重细菌感染的受试者。使用定量免疫测定法测量降钙素原。

结果

在13个月的时间里，对271名婴儿进行了降钙素原检测。有44名（16%）患有严重细菌感染的患者，近期接种疫苗组有35名，近期未接种疫苗组有192名。严重细菌感染患者的降钙素原中位数水平为0.53 ng/mL，近期接种疫苗患者为0.29 ng/mL，近期未接种疫苗患者为0.17 ng/mL。与近期接种和未接种疫苗的患者相比，严重细菌感染患者的降钙素原值升高。与近期未接种疫苗的患者相比，近期接种疫苗患者的降钙素原水平升高。使用0.12 ng/mL的切点，降钙素原对严重细菌感染的敏感性为96%，特异性为23%，阴性预测值为96%。通过该切点确定了2名近期接种疫苗且患有严重细菌感染的患者。