From the Guidelines
Procalcitonin is a useful biomarker in pediatric patients to guide antibiotic therapy decisions, particularly in cases of suspected bacterial infections, with levels <0.25 ng/mL suggesting a reduced risk of typical bacterial detection. When interpreting procalcitonin levels, it is essential to consider the clinical context, as levels may be elevated in non-infectious conditions like trauma, surgery, and certain autoimmune disorders 1. In pediatric patients with community-acquired pneumonia, lower procalcitonin concentrations (<0.25 ng/mL) were associated with a reduced risk of typical bacterial detection, suggesting that procalcitonin-guided therapy could identify children who do not require antibiotic treatment 1.
Some key points to consider when using procalcitonin in pediatric patients include:
- Procalcitonin levels <0.25 ng/mL may indicate a reduced risk of bacterial infection
- Levels >0.25 ng/mL may suggest the need for antibiotic therapy
- Clinical judgment remains essential when interpreting procalcitonin results, as false negatives can occur with localized infections or very early in the disease course
- Procalcitonin has a half-life of 24-30 hours, making it more responsive than C-reactive protein 1
In terms of guiding antibiotic therapy decisions, procalcitonin levels can help identify pediatric patients who do not require antibiotic treatment, potentially reducing antibiotic exposure and adverse outcomes. A meta-analysis of adult patients found that the use of procalcitonin to guide therapy was associated with a 17% reduced risk of mortality and a 2.4-day reduction in antibiotic exposure compared with controls, without increasing adverse outcomes 1. While data in children are scarce, the available evidence suggests that procalcitonin can be a valuable tool in guiding antibiotic therapy decisions in pediatric patients.
From the Research
Clinical Applications of Procalcitonin in Pediatrics
- Procalcitonin is a useful biomarker for the diagnosis of infection in pediatric populations, particularly in differentiating systemic inflammatory response syndrome (SIRS) from sepsis 2, 3.
- It has been shown to have higher diagnostic accuracy compared to traditional biomarkers such as complete blood counts and C-reactive protein 2.
- Procalcitonin can be used as a prognostic marker in pediatric trauma and burn patients, aiding in the identification of infection in patients with extensive underlying inflammation 2.
Diagnostic and Prognostic Utility of Procalcitonin
- Procalcitonin is a reliable indicator of infection in children, with typical values for maximal sensitivity and specificity being less than 0.5 ng/ml for noninfectious inflammation and greater than 2.0 ng/ml for bacterial sepsis 3.
- It has been shown to perform better than C-reactive protein in some settings, although more pediatric comparative data are needed 3.
- Procalcitonin can aid in diagnosing infection in challenging patient populations, such as those with sickle cell disease, congenital heart defects, neutropenia, and indwelling central venous catheters 3.
Procalcitonin as a Marker of Bacterial Infection
- Procalcitonin is an early marker for the detection of severe, invasive bacterial infection in children 4.
- Age-specific cut-off, underlying syndrome, and maternal antibiotics usage should be considered when using procalcitonin in neonates 4.
- Procalcitonin can be used as a prognostic indicator, particularly for sepsis and urinary tract infection, due to its correlation with the severity of infection 4.
Management of Pediatric Sepsis
- Procalcitonin has several advantages over traditional biomarkers in the management of pediatric sepsis, including supporting earlier antibiotic discontinuations and reducing unnecessary antibiotic use 5.
- When used in combination with other clinical and laboratory data, or measured over time, procalcitonin can help reduce antibiotic exposure without increasing treatment failure 3, 5.