Fisler Grace, Brandt Timothy, Ostovar G Amin, Taylor Matthew D, Shah Sareen
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, Donald and Barbara Zucker School of Medicine, New York, USA.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, The Children's Hospital at Montefiore, New York, USA.
Infect Dis Clin Microbiol. 2023 Dec 29;5(4):287-291. doi: 10.36519/idcm.2023.300. eCollection 2023 Dec.
Elevated procalcitonin levels have been associated with bacterial infection in children. Observational studies reported high procalcitonin values in COVID-19. Data on bacterial coinfections in pediatric COVID-19 is sparse; small studies suggest a low coinfection rate. In this study, we aimed to quantify the positive predictive value (PPV) of procalcitonin in identifying bacterial infection in children with and without COVID-19.
A retrospective chart review was performed for 215 children <21 years admitted to our tertiary children's hospital between February 1, 2013, and July 15, 2020, who had procalcitonin levels measured within 48 hours of admission. Confirmed bacterial infection was defined as positive blood, urine, or cerebrospinal fluid (CSF) culture, positive endotracheal culture with evidence of leukocytosis on Gram stain, or pneumonia by chest radiograph. Suspected bacterial infection was defined as confirmed bacterial infection or administration of antibiotics for >48 hours.
Of the 215 patients, 73 were admitted for COVID-19 (66% multisystem inflammatory syndrome in children [MIS-C], 34% acute COVID-19). The PPV of an elevated procalcitonin level >1.0 ng/mL in identifying suspected bacterial infections for those with MIS-C was 6.3% (95% CI=0-15), in acute COVID-19 was 29% (95% CI=0-62%), and in the non-COVID-19 cohort was 75% (95% CI=62-88%). For identification of confirmed bacterial infection, PPV of an elevated procalcitonin level was 0% in MIS-C, 14% (95% CI=0-40%) in acute COVID-19, and 55% (95% CI=40-69%) in the non-COVID-19 cohort.
We found a low PPV of elevated procalcitonin level above 1 ng/mL in identifying either culture-confirmed or presumed bacterial infection in children hospitalized with COVID-19-related illness.
降钙素原水平升高与儿童细菌感染有关。观察性研究报告称，新冠病毒病（COVID-19）患者的降钙素原值较高。关于儿童COVID-19合并细菌感染的数据稀少；小型研究表明合并感染率较低。在本研究中，我们旨在量化降钙素原在识别有或无COVID-19儿童细菌感染中的阳性预测值（PPV）。
对2013年2月1日至2020年7月15日期间入住我院三级儿童医院的215名21岁以下儿童进行回顾性病历审查，这些儿童在入院后48小时内检测了降钙素原水平。确诊的细菌感染定义为血、尿或脑脊液（CSF）培养阳性、气管内培养阳性且革兰氏染色显示白细胞增多，或胸部X线片显示肺炎。疑似细菌感染定义为确诊的细菌感染或使用抗生素超过48小时。
215例患者中，73例因COVID-19入院（66%为儿童多系统炎症综合征[MIS-C]，34%为急性COVID-19）。降钙素原水平>1.0 ng/mL在识别MIS-C患者疑似细菌感染中的PPV为6.3%（95%CI=0-15），急性COVID-19患者中为29%（95%CI=0-62%），非COVID-19队列中为75%（95%CI=62-88%）。对于确诊的细菌感染，降钙素原水平升高在MIS-C中的PPV为0%，急性COVID-19中为14%（95%CI=0-40%），非COVID-19队列中为55%（95%CI=40-69%）。
我们发现，降钙素原水平高于1 ng/mL在识别因COVID-19相关疾病住院儿童的培养确诊或疑似细菌感染方面，阳性预测值较低。
