Laham James L, Breheny Patrick J, Gardner Brian M, Bada Henrietta
From the *Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Kentucky Chandler Medical Center; †College of Public Health, Department of Biostatistics, ‡Pharmacy Services, University of Kentucky; and §Division of Neonatology, Department of Pediatrics, University of Kentucky Chandler Medical Center, Lexington, KY.
Pediatr Emerg Care. 2014 Jan;30(1):11-5. doi: 10.1097/PEC.0000000000000026.
The aim of this study was to conduct a preliminary analysis of serum procalcitonin (PCT) to predict bacterial coinfection in infants with acute bronchiolitis.
Retrospective cohort chart review of 40 infants admitted with acute bronchiolitis to the pediatric intensive care unit. Logistic regression models were used to determine the association of PCT and white blood count with presence of bacterial coinfection defined by either positive culture or chest radiograph result.
Fifteen (38%) of 40 patients had a diagnosis of bacterial coinfection by positive culture (9/15) or chest radiograph (6/15). Procalcitonin (P < 0.0001) was significantly associated with bacterial coinfection. A cutoff value of 1.5 ng/mL had sensitivity of 0.80, specificity of 1.00, and area under the operating curve of 0.88. White blood count (P = 0.06) was borderline significant with sensitivity of 0.33, specificity of 0.96, and area under the operating curve of 0.67. Three of 15 patients were later found to have bacterial coinfection with initial PCT of less than 1.5 ng/mL. None had follow-up PCT measurements taken. Thirty-five of 40 were prescribed empiric antibiotic therapy, including 20 of 25 patients without evidence of bacterial coinfection. None had a PCT of greater than 1.5 ng/mL. If a PCT cutoff of greater than 1.5 ng/mL had been used, 57% fewer patients would have received antibiotics with a 45% reduction in antimicrobial charges.
An elevated PCT may assist clinicians in determining presence of bacterial coinfection at admission in infants with acute bronchiolitis. Implementation of a PCT cutoff of 1.5 ng/mL at admission may prevent unnecessary antibiotic use with associated cost savings. Serial PCT levels may increase sensitivity. Further validation is warranted.
本研究旨在对血清降钙素原（PCT）进行初步分析，以预测急性细支气管炎婴儿的细菌合并感染。
对40例入住儿科重症监护病房的急性细支气管炎婴儿进行回顾性队列图表审查。采用逻辑回归模型确定PCT和白细胞计数与通过阳性培养或胸部X线片结果定义的细菌合并感染的相关性。
40例患者中有15例（38%）通过阳性培养（9/15）或胸部X线片（6/15）诊断为细菌合并感染。降钙素原（P<0.0001）与细菌合并感染显著相关。截断值为1.5 ng/mL时，敏感性为0.80，特异性为1.00，曲线下面积为0.88。白细胞计数（P = 0.06）临界显著，敏感性为0.33，特异性为0.96，曲线下面积为0.67。15例患者中有3例后来被发现细菌合并感染，初始PCT低于1.5 ng/mL。均未进行后续PCT测量。40例中有35例接受了经验性抗生素治疗，包括25例无细菌合并感染证据患者中的20例。均无PCT大于1.5 ng/mL。如果使用大于1.5 ng/mL的PCT截断值，接受抗生素治疗的患者将减少57%，抗菌费用降低45%。
PCT升高可能有助于临床医生确定急性细支气管炎婴儿入院时是否存在细菌合并感染。入院时采用1.5 ng/mL的PCT截断值可能避免不必要的抗生素使用并节省相关费用。连续PCT水平可能提高敏感性。需要进一步验证。
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