Journal Club: A new way to detect SBIs in febrile infants

To determine if procalcitonin levels are useful as a single clinical marker of serious bacterial infection (SBI) in young febrile infants, investigators conducted a study in more than 200 such infants who were brought to an urban pediatric emergency department. The infants were no more than 90 days old and had no identifiable source of fever. Investigators measured the infants' procalcitonin levels using a new automated, sensitive assay.

Of a total of 234 infants (with a median age of 51 days), 30 (12.8%) had definite SBIs, including bacteremia, bacteremia with urinary tract infections (UTIs), and UTIs. Twelve infants (5.1%) had possible serious bacterial infections: pneumonia and UTIs. Mean procalcitonin levels for definite SBIs were 2.21 ng/mL and for definite and possible SBIs combined a mean of 2.48 ng/mL. These figures compared with a mean procalcitonin level of 0.38 ng/mL in infants with no SBI. Investigators determined that for identifying definite and possible SBIs, a procalcitonin cutoff value of 0.12 ng/mL had a sensitivity of 95.2% and a specificity of 25.5% (Maniaci V et al: Pediatrics 2008;122:701).

Commentary

Dr. Burke, section editor for Journal Club, is Chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore. He is a contributing editor for Contemporary Pediatrics. He has nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article.