Background: Although low procalcitonin (PCT) concentrations are associated with a reduced risk of bacterial pneumonia in adults, their clinical utility in children is unclear. We assessed whether serum PCT concentrations in hospitalized children with radiologically-confirmed community-acquired pneumonia (CAP) were associated with etiology and severity.
Methods: Sera collected at admission from children hospitalized with CAP at one Utah hospital enrolled in the CDC Etiology of Pneumonia in the Community (EPIC) Study were tested retrospectively using the bioMérieux VIDAS BRAHMS PCT assay. Admission naso/oropharyngeal swabs were collected for respiratory viral and atypical bacterial testing by PCR and blood was collected for culture and whole blood PCR (S. pneumoniae and S. pyogenes). Pleural fluid cultures and PCR were performed when indicated. We used multivariable regression to test associations between PCT concentrations, pathogen detection, and severity.
Results: 532/797 (67%) children (median age 2.4 years; interquartile range [IQR]: 1.0-6.3) had archived serum samples and were included. The median PCT concentration was 0.33 (IQR: 0.10-1.55) ng/mL. Patients with non-atypical bacterial detection had higher PCT concentrations (median 4.98 [IQR: 0.76-19.97] ng/mL) than those with Mycoplasma detected (median 0.10 [IQR: 0.06-0.31] ng/mL), a viral pathogen alone (median 0.33 [IQR: 0.12-1.34] ng/mL), or no pathogen identified (median 0.44 [IQR: 0.10-1.83] ng/mL) (P<0.001 for all; Figure). Lower PCT concentrations were associated with a decreased odds of ICU admission (P<0.01), empyema (P=0.02), and longer hospital stay (P<0.01). Using a PCT cut-off of <0.25 ng/mL, 11/532 (2%) children had a bacteria other than Mycoplasma detected.
Conclusion: Low PCT concentrations in children hospitalized with CAP were associated with a reduced risk of bacterial detection and ICU admission. Prospective studies are needed to evaluate whether PCT concentrations in conjunction with clinical, laboratory, and etiologic data can be used to differentiate children at low and high risk of bacterial CAP and inform the need for antibiotic treatment.
J. Killpack, None
D. J. Williams, None
K. Edwards, None
C. G. Grijalva, None
S. R. Arnold, None
J. A. Mccullers, None
E. J. Anderson, Abbvie: Consultant , Consulting fee
MedImmune: Editorial assistance , Assistance in writing a manuscript
Roche: Editorial assistance , Assistance in writing a manuscript
R. G. Wunderink, bioMerieux: Consultant and Grant Investigator , Consulting fee and Research grant
W. H. Self, None
A. M. Bramley, None
S. Jain, None
A. J. Blaschke, BioFire Diagnostics, LLC: Collaborator , Consultant and Scientific Advisor , Consulting fee , Licensing agreement or royalty and Research support
bioMerieux, Inc: Collaborator , Investigator and Scientific Advisor , Consulting fee and Research support
Merck: Investigator , Research grant