1759. Procalcitonin Concentrations among Hospitalized Children with Pneumonia - Associations with Etiology and Prognosis
Session: Poster Abstract Session: Pediatric Bacterial Infections
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDWeek 2015_Procalcitonin Poster_FINAL.pdf (5.7 MB)
  • 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.

    Chris Stockmann, MSc1, Krow Ampofo, MD, FIDSA, FPIDS1, Jarrett Killpack, BSc1, Derek J. Williams, MD, MPH2, Kathryn Edwards, MD, FIDSA3, Carlos G. Grijalva, MD, MPH4, Sandra R. Arnold, MD5, Jonathan a. Mccullers, MD, FIDSA6, Evan J. Anderson, MD7, Richard G. Wunderink, MD8, Wesley H. Self, MD, MPH9, Anna M. Bramley, MPH10, Seema Jain, MD, MPH11 and Anne J. Blaschke, MD, PhD, FIDSA, FPIDS1, (1)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (2)Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, (3)Pediatrics, Vanderbilt University Medical Center, Nashville, TN, (4)Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, (5)Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, (6)St. Jude Children's Research Hospital, Memphis, TN, (7)Pediatrics and Medicine, Emory University School of Medicine, Atlanta, GA, (8)Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, (9)Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, (10)Centers for Disease Control and Prevention (CDC), Atlanta, GA, (11)Centers for Disease Control and Prevention, Atlanta, GA

    Disclosures:

    C. Stockmann, None

    K. Ampofo, None

    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

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.