BACKGROUND. Procalcitonin has been identified as a useful blood marker of serious bacterial infection in febrile infants.

Many infants present with a febrile reaction after receiving immunizations. The effects of immunization on procalcitonin have not been investigated. METHODS.We performed a prospective observational cohort study at a large, urban pediatric emergency department. Infants _90 days of age with fever of _38°C were enrolled. Subjects were divided into 3 groups: infants with serious bacterial infection; subjects without serious bacterial infection who received recent (_48 hours) immunizations; and subjects without serious bacterial infection who did not recently receive immunizations. Procalcitonin was measured by using a quantitative immunometric assay. RESULTS. Over 13 months, procalcitonin was measured for 271 infants. There were 44 (16%) patients with serious bacterial infection, 35 in the recent-immunization group, and 192 in the no-recentimmunization group. The median procalcitonin level for serious bacterial infection was 0.53 ng/mL, for recent immunization was 0.29 ng/mL, and for no recent immunizations was 0.17 ng/mL. Procalcitonin values were elevated for patients with serious bacterial infection compared with patients both with and without recent immunizations. Compared with patients who had no recent immunizations, procalcitonin levels were elevated in patients with recent immunization. Using a cut point of 0.12 ng/mL, the sensitivity of procalcitonin for serious bacterial infection was 96%, specificity was 23%, and negative predictive value was 96%. Two patients with recent immunization who had serious bacterial infection were identified with this cut point. CONCLUSIONS. Among febrile infants with recent immunization, procalcitonin levels are increased compared with patients with fever and no identified bacterial infection. Despite this increase, procalcitonin can still reliably discriminate infants with serious bacterial infection. Pediatrics 2008;122:e1119– e1122 FEVER WITHOUT AN identifiable source of infection is a common presenting complaint at primary care offices and emergency departments. For infants _3 months of age, fever may be the only sign of a serious bacterial infection (SBI). In addition, infants routinely receive their first group of vaccinations between 6 and 10 weeks of age. With the advent of the Pediarix (GlaxoSmithKline, Research Triangle Park, NC) vaccine, there have been reported rates of fever after vaccination as high as 27.9%.1 There is no standard evaluation or management of fever in recently vaccinated

Division of Endocrinology.2–6 We previously reported the procalcitonin values in a prospective cohort of infants _90 days old who presented to a pediatric emergency department with fever without source. vaccination. METHODS This study was part of a larger study investigating the performance of procalcitonin as a discriminator of SBI in this age group. E-mail: andrew. harvard. 1098-4275). LO-605. UTI. 0031-4005. urine. we investigate the effect of recent immunization on the diagnostic performance of procalcitonin in young febrile infants. MD. procalcitonin Abbreviations: WBC. Copyright © 2008 by the American Academy of Pediatrics PEDIATRICS Volume 122. urinary tract infection. white blood cell.2008-1884 Accepted for publication Jul 21. negative predictive value www. infant. NPV.1542/ PEDIATRICS (ISSN Numbers: Print. The first group included all patients with an SBI regardless of . Recent studies have identified procalcitonin as a biomarker of bacterial°C. Patients were classified as having an SBI if they had a blood. recent immunization. no recent immunization. Children’s Hospital Boston. The effect of immunization on procalcitonin levels has not been well described and theoretically might interfere with the use of procalcitonin as a diagnostic marker for SBI. 2008 Address correspondence to Andrew Dauber. Herein. serious bacterial infection. 300 Longwood Ave.2008-1884 doi:10. Subjects were divided into 3 groups.7 Procalcitonin was found to be a highly sensitive marker of SBI in this cohort. RI. immunization. Infants were excluded if they had an Key Words: fever.pediatrics. Provided by Indonesia:AAP Sponsored on December 12. MA 02115. 2010 underlying chronic illness or antibiotic use within the previous 48 hours.1542/peds.pediatrics. CI. or cerebrospinal culture that grew a pathogenic organism or had a chest radiograph that was interpreted by an attending radiologist who diagnosed pneumonia. Boston. We conducted a prospective cohort study of infants _90 days of age who presented to the emergency department with a documented temperature of _38. NRI.7 The complete study methods are detailed in the original publication. November 2008 e1119 Downloaded from www. Online.dauber@childrens. confidence interval. Number 5.

The third group included those patients without SBI who had not received immunizations in the previous 48 hours (NRI group). 4 were bacteremia. IL).their recent immunization status (SBI group). Of the remaining 822 patients. for categorical data. and 192 (71%) patients in the NRI group. Analyses were performed between the SBI and RI groups. and RI and NRI groups. 33 were urinary tract infections (UTIs). The white blood cell (WBC) and procalcitonin data for the 3 groups are presented in Table 1. At the time of enrollment. WBC values were significantly higher in the SBI and RI groups when . consent was obtained for 501 (61%) of them. Germany] procalcitonin-sensitive Kryptor kit). College Station. the attending physician responsible for the care of the patient completed a questionnaire to assess the appearance of the infant on a 5-point scale. Fisher’s exact test or _2 analysis was used. The 95% confidence intervals (CIs) for proportions were calculated by using Stata 6 (Stata Corp. Fifty-two patients met the exclusion criteria. the mean age of patients in the RI group was significantly higher than in the SBI and NRI groups. As predicted by the timing of immunizations. we were able to measure the procalcitonin level from an available blood specimen in 271 patients (54% of consented eligible patients). Of those patients. The second group included those patients without SBI who had received immunizations within the previous 48 hours (RI group). Procalcitonin was measured on stored samples by using an immunometric assay (Brahms [Hennigsdorf. RESULTS During the study period. The patients were significantly more well-appearing in the RI group in comparison to those in the SBI group but not in comparison to those in the NRI group. 874 infants _90 days old with a temperature of _38°C were evaluated in the emergency department. 2 were UTIs with bacteremia. Demographics of the infants in these 3 groups are presented in Table 1. Of the 44 SBIs. independentsamples t tests and the nonparametric Wilcoxon rank-sum test were used. Chicago. and 5 were pneumonia. 35 (13%) patients in the RI group.0 (SPSS Inc. Of the 271 patients comprising the study group. TX). For continuous variables. The study was approved by the Children’s Hospital Boston institutional review board and was compliant with the Health Insurance Portability and Accountability Act of 1996. the SBI and NRI groups. there were 44 (16%) patients in the SBI group. Statistical analysis was performed by using SPSS 14.

2) .4°C. Her procalcitonin level was 0.53) 38. Using our previously published cut point of 0.6 (0. This calculation was limited by the small sample size of 2 patients with SBI and recent immunizations. the sensitivity of procalcitonin for SBI in the entire cohort was 96% (95% CI: 83%–99%).8 This presents a unique problem in those infants _3 months of age who are at higher risk of having an SBI.32 Overall appearance.133 . median (IQR)a 4 (4–5) 5 (4–5) 4 (4–5) . Her urine culture grew _100 000 colony-forming units/mL Escherichia coli.7) 11.207 . The procalcitonin levels in the RI group were also higher than in the NRI group. Figure 1 depicts the distribution of procalcitonin values in the SBI.36 ng/mL.002 Highest temperature. TABLE 1 Comparison of the Study Subgroups SBI Group (N_44) RI Group (N_35) NRI Group (N_192) P SBI vs RI SBI vs NRI RI vs NRI Age.781 _.019 . mean (SD). RI and NRI groups.12 ng/ mL.002 .8 (4. DISCUSSION Fever is the most frequently reported “serious” and “nonserious” adverse event after immunization according to the Vaccine Adverse Event Reporting System. His urine culture grew 30 000 colony-forming units/mL E coli.6% (3 of 35).211 ng/mL. d 45 (25) 63 (7) 51 (23) _. the sensitivity of procalcitonin for SBI was 100% (2 of 2).2 (4. the specificity was 23% (95% CI: 18%–29%). and the specificity for non-SBI was 8. °C 38.0°C who had received immunizations 2 days before presentation.001 . Two of 37 patients with recent immunization had an SBI. Median procalcitonin levels were significantly higher in the SBI group when compared with both the RI and NRI groups.46) .68) 38. There was no difference in the mean WBC count between the RI and SBI groups. mean (SD). and the negative predictive value (NPV) was 96% (95% CI: 86%–99%). His procalcitonin level was 0.8) 13. The second patient was a 71-day-old boy who had received immunizations earlier that day and presented with a temperature of 38.001 .112 WBC.118 .9 (0.7 (0.001 .3 (7. The first patient was a 77-day-old girl with a temperature of 40. mean (SD). 103/_L 14.compared with the NRI group. Using the same cut point for the 37 patients who had received immunizations in the past 48 hours (35 in the RI group and 2 with recent immunization in the SBI group).

toxic. 2010 There is no consensus on whether to treat these patients differently than those with fever and no recent history of immunization.53 (0.6 ng/mL). The WBC count was also elevated in the RI group when compared with non-SBI patients without recent immunization . ng/mL 0.Procalcitonin. “moribund. 5. but it can still be used to identify a group at low risk for SBI regardless of immunization status. We previously reported the utility of procalcitonin level for predicting SBI in those patients who had not received immunizations in the previous 48 hours. A Medline database search revealed only 1 article about procalcitonin levels after vaccination: in a letter to the editor of the Pediatric Infectious Disease Journal. The median procalcitonin level was significantly higher in the group of infants who had received immunizations compared with those who had not.41) 0. There were no SBIs.29 (0.9 Korczowski reported on a cohort of 17 patients who presented to a pediatric emergency department in Poland with vaccination-associated adverse events.12 ng/mL had a sensitivity of 95% (95% CI: 83%–99%). interactive infant.001 . The mean serum procalcitonin level in these patients was 0.9 ng/mL (range: 0. we further subcategorized the patients as those with SBI.5°C. unresponsive”. “perfectly healthy.12– 0. The mean age of the infants was 20 weeks (range: 6–37 weeks). NPV of 96% (95% CI: 85%–99%).001 IQR indicates interquartile range.8 _ 0. and negative likelihood ratio of 0. In that On the basis of this.17 (0.18–2.27) . but it was significantly lower than in the SBI group. The effect of vaccination on procalcitonin levels has not been well studied. median (IQR). Ours was a prospective cohort study that included 271 infants _90 days old with documented temperatures of _38°C in a pediatric emergency department. a cut point of 0.” e1120 DAUBER et al Downloaded from www.18–0. specificity of 26% (95% CI: 20%–32%). a Appearance scale: 1.017 _. ill appearing.pediatrics.19 (95% CI: 0.74). Sixteen of these patients had temperatures of _38. it seems that immunization leads to an increase in serum procalcitonin values.1–3.50) 0. Korczowski concluded that procalcitonin levels can be modestly elevated after vaccination in the absence of infection. and those without SBI who had not recently received immunizations. those without SBI who had recently received immunizations. In the current study.05–0. all cases of bacteremia were identified accurately with the cut-point value. Provided by Indonesia:AAP Sponsored on December 12.

Our study has several limitations. both patients in our cohort with SBIs who had recently received immunizations were identified. thus. When using our previously published cut point of 0. SBI RI NRI Study subgroup 5 4 3 2 1 0 Procalcitonin. Number 5. PEDIATRICS Volume 122. WBC count. Furthermore. Therefore. The whiskers represent 1. because we were hoping to identify a low-risk group for SBI.pediatrics. procalcitonin levels can continue to be used to identify patients at low risk for SBI. is less useful for patients who have recently received vaccinations. We acknowledge that some of the patients with low-colony-count UTIs and radiographic pneumonia may not have represented . we did not collect information on the type of vaccinations received and. therefore.but was similar to those with SBI. the addition of vaccinated infants into the analysis of the entire cohort led to a similar sensitivity and NPV but decreased the specificity of procalcitonin level as a marker of SBI. In addition. and by using the same cut point. may not represent the larger population of patients after immunization. November 2008 e1121 Downloaded from www. even among those febrile infants who were recently vaccinated and presented with fever. cannot provide further details on the specific effects of individual vaccines on procalcitonin values.12 ng/mL. the sensitivity of procalcitonin for SBI in the entire cohort was 96% (95% CI: 83%–99%).org. The boxes represent the limits of the 25th and 75th percentiles and are divided with a line at the median. Overall. and NPV was 96% (95% CI: 86%–99%). a commonly used marker for SBI. ng/mL FIGURE 1 Comparison of the study subgroups. 2010 Finally. The study was conducted at an academic pediatric emergency department and. Provided by Indonesia:AAP Sponsored on December 12. specificity was 23% (95% CI: 18%–29%). However. This change is because of the vast majority of immunized patients having a procalcitonin value that was greater than our cut point of 0. there may be a bias of who had any laboratory evaluation. our definitions of SBI were intended to be conservative to include all possible SBIs.12 ng/mL.5 times the IQR.

MD. or manuscript preparation. Procalcitonin diukur dengan menggunakan uji immunometric kuantitatif. The Children’s Hospital Boston General Clinical Research Center was involved in sample processing terjemahan. National Institutes of Health grant M01RR02172). Despite this increase. procalcitonin levels can still reliably discriminate infants with SBI. BS. Our initial study provides further analysis on definite and possible SBIs to account for this difficulty in definitions. dan subyek tanpa infeksi bakteri serius yang tidak baru-baru menerima imunisasi.We melakukan studi kohort prospektif observasional di sebuah departemen. Procalcitonin telah diidentifikasi sebagai penanda darah yang berguna infeksi bakteri serius pada bayi demam. Jr. CONCLUSIONS Among young febrile infants with recent immunization. Resident Research Fund and the American Academy of Pediatrics Resident Research Grant. Subyek dibagi menjadi 3 kelompok: bayi dengan serius infeksi bakteri. Selama 13 bulan. We are thankful for the financial support of the Frederick H. and Robyn Neches. PhD. subyek tanpa infeksi bakteri serius yang menerima terakhir (_48 jam) imunisasi. The funding organizations had no role in the design. METHODS. procalcitonin levels are increased compared with patients with fever and no identified bacterial infection. Banyak bayi hadir dengan reaksi demam setelah menerima imunisasi. for work on the procalcitonin assays. procalcitonin diukur untuk 271 bayi. we acknowledge technical support related to specimen processing by the General Clinical Research Center at Children’s Hospital Boston (National Center for Research Resources. ACKNOWLEDGMENTS We thank the physician colleagues in the emergency department who facilitated enrollment for the study. General Clinical Research Centers Program. Lovejoy.true bacterial infections. Ada 44 (16%) pasien dengan serius . HASIL. data analysis. darurat kota besar pediatrik. Bayi usia _90 hari dengan demam _38 ° C yang terdaftar. LATAR BELAKANG. Efek dari imunisasi pada procalcitonin belum diselidiki. and we gratefully acknowledge the help and expertise of Richard Snider. In addition.

35 dalam kelompok terakhir-imunisasi. untuk imunisasi terakhir adalah 0. spesifisitas adalah 23%. Menggunakan titik potong dari 0.12 ng / mL. Kami melakukan prospektif . tingkat procalcitonin meningkat pada pasien dengan imunisasi terakhir.1 Tidak ada standar evaluasi atau manajemen demam pada baru-baru divaksinasi bayi. Dibandingkan dengan pasien yang tidak memiliki imunisasi terakhir. bayi secara rutin Kelompok pertama menerima mereka vaksinasi antara 6 dan 10 minggu usia. kepekaan procalcitonin untuk infeksi bakteri yang serius adalah 96%. procalcitonin masih bisa dipercaya diskriminasi bayi dengan infeksi bakteri serius. 122: e1119-e1122 TANPA DEMAM AN diidentifikasi sumber infeksi menyajikan keluhan umum di perawatan primer kantor dan departemen darurat.29 ng / mL. Median tingkat procalcitonin untuk infeksi bakteri yang serius adalah 0. Selain itu. ada telah dilaporkan tingkat demam setelah vaksinasi setinggi 27. Penelitian terbaru telah mengidentifikasi procalcitonin sebagai biomarker bakteri infections. Di sini. KESIMPULAN. Meskipun peningkatan ini. Untuk bayi _3 bulan usia. dan negatif nilai prediksi adalah 96%.7 Procalcitonin ditemukan untuk menjadi sangat sensitif penanda SBI pada kohort ini. Dengan munculnya Pediarix yang (GlaxoSmithKline.7 Metode studi lengkap yang rinci dalam publikasi asli. kami menyelidiki efek dari imunisasi baru pada kinerja diagnostik procalcitonin di muda demam bayi. dan 192 pada kelompok tidakterakhir-imunisasi. Pediatri 2008. Dua pasien dengan imunisasi terakhir yang mengalami infeksi bakteri serius diidentifikasi dengan titik potong. Efek dari imunisasi pada tingkat procalcitonin belum dijelaskan dengan baik dan secara teoritis dapat mengganggu penggunaan dari procalcitonin sebagai penanda diagnostik untuk SBI. tingkat procalcitonin meningkat dibandingkan dengan pasien dengan demam dan tidak ada infeksi bakteri diidentifikasi. dan untuk tidak ada imunisasi terakhir adalah 0.infeksi bakteri. Research Triangle Park. Di antara bayi demam dengan imunisasi terakhir. Nilai Procalcitonin terangkat untuk pasien dengan bakteri yang serius infeksi dibandingkan dengan pasien baik dengan dan tanpa imunisasi terakhir.17 ng / mL.9% .53 ng / mL. demam bisa jadi hanya tanda yang serius infeksi bakteri (SBI).2-6 Kami sebelumnya dilaporkan nilai-nilai procalcitonin dalam kohort prospektif bayi _90 hari tua yang disajikan kepada anak-anak gawat darurat dengan demam tanpa source. NC) vaksin. METODE Penelitian ini merupakan bagian dari penelitian yang lebih besar menyelidiki kinerja procalcitonin sebagai diskriminator SBI di usia ini group.

interval kepercayaan. Analisis dilakukan antara SBI dan kelompok RI. 0031-4005. Online. bayi. infeksi bakteri yang serius. Divisi Endokrinologi. MD. dokter yang hadir bertanggung jawab untuk perawatan pasien menyelesaikan kuesioner untuk menilai penampilan bayi pada titik 5skala. Jerman] procalcitonin-sensitif kit Kryptor). urin. untuk data Pediatrics (ISSN Nomor: Cetak. Analisis statistik dilakukan dengan menggunakan SPSS 14. 21 Juli 2008 Alamat korespondensi untuk Andrew pengoles. NPV.2008-1884 Diterima untuk publikasi. Subyek dibagi menjadi 3 kelompok. infeksi saluran kemih. SBI dan Kelompok NRI.0 (SPSS Inc. imunisasi terakhir. Hak Cipta © 2008 oleh American Academy of Pediatrics Pediatri Volume 122.2008-1884 doi: 10. Uji eksak Fisher atau _2 analisis digunakan. nilai prediksi negatif www. imunisasi. Para Kelompok pertama termasuk semua pasien dengan SBI terlepas dari mereka terakhir imunisasi status (SBI kelompok). November 2008 e1119 Download dari www. Procalcitonin diukur pada sampel yang disimpan oleh menggunakan uji immunometric (Brahms [Hennigsdorf. Kepercayaan 95% interval (CI) untuk proporsi dihitung dengan menggunakan . IL). dan RI dan kelompok NRI. procalcitonin Singkatan: SBI. RI. Pasien diklasifikasikan sebagai memiliki SBI jika mereka memiliki darah. darah putih sel. tidak barubaru ini imunisasi. atau budaya serebrospinal yang tumbuh patogen yang organisme atau memiliki radiograf dada yang ditafsirkan oleh seorang ahli radiologi menghadiri yang didiagnosis pneumonia. 300 Longwood Ave. studi _90 hari bayi usia yang disampaikan kepada departemen darurat dengan suhu didokumentasikan dari _38.pediatrics. E-mail: andrew. Chicago. harvard.0 ° C.1542/peds. 1098-4275). Pada saat pendaftaran. Boston. Diberikan oleh Indonesia: AAP sponsor pada 12 Desember 2010 kronis yang mendasari penyakit atau penggunaan antibiotik dalam sebelumnya 48 jam. Yang kedua termasuk kelompok pasien tanpa SBI yang telah menerima imunisasi dalam waktu 48 jam sebelumnya (Kelompok RI).1542/peds. Kelompok ketiga termasuk pasien tanpa SBI yang belum menerima imunisasi di sebelumnya 48 jam (NRI kelompok). Untuk variabel kontinyu. MA 02115. mandirisampel t tes dan Wilcoxon nonparametrik rank-sum test digunakan. LO-605. WBC.pediatrics. Nomor 5. Bayi dikeluarkan jika mereka memiliki Kata Kunci: demam.dauber @ anak-anak. Rumah Sakit Anak Boston. ISK. NRI. CI.

35 (13%) pasien dalam kelompok RI. Kultur urin nya tumbuh 30 000 pembentuk koloni unit / mL E coli. kita mampu mengukur tingkat procalcitonin dari darah yang tersedia spesimen dalam 271 pasien (54% dari persetujuan pasien yang memenuhi kriteria). 2 adalah UTI dengan bakteremia.211 ng / mL. ada adalah 44 (16%) pasien dalam kelompok SBI. RI dan NRI kelompok. HASIL Selama masa penelitian. Para pasien secara signifikan lebih baik muncul pada kelompok RI dibandingkan kepada mereka dalam kelompok SBI tetapi tidak dibandingkan dengan pada kelompok NRI. dan 192 (71%) pasien dalam NRI kelompok. Sel darah putih (WBC) dan data procalcitonin untuk 3 kelompok disajikan pada Tabel 1. Menggunakan dipotong diterbitkan sebelumnya kami titik 0. dan 5 pneumonia. Nya tingkat procalcitonin adalah 0. Dua dari 37 pasien dengan imunisasi terakhir memiliki SBI. 33 adalah infeksi saluran kemih (UTI). Sebagai diprediksi oleh waktu imunisasi. Demografi dari bayi dalam 3 kelompok disajikan pada Tabel 1. 4 adalah bakteremia. 874 bayi _90 hari tua dengan suhu _38 ° C dievaluasi dalam keadaan darurat departemen.Stata 6 (Stata Corp. Tingkat procalcitonin median secara signifikan lebih tinggi pada SBI kelompok bila dibandingkan dengan kedua RI dan NRI kelompok. Lima puluh dua pasien bertemu pengecualian kriteria. Kultur urin nya tumbuh _100 000 unit pembentuk koloni / mL Escherichia coli. kepekaan procalcitonin untuk SBI di seluruh . Tingkat procalcitonin dalam kelompok RI yang juga lebih tinggi dari pada kelompok NRI.4 ° C.36 ng / mL. Tidak ada perbedaan dalam hitungan WBC rata-rata antara RI dan kelompok SBI. Dari 271 pasien yang terdiri dari kelompok studi. TX). Penelitian ini disetujui oleh Rumah Sakit Anak Boston papan review kelembagaan dan sesuai dengan Asuransi Kesehatan Portabilitas dan Akuntabilitas Act of 1996. Tingkat procalcitonin Nya adalah 0. Pasien pertama adalah seorang gadis 77-hari-tua dengan suhu dari 40.12 ng / mL. Dari pasien. Dari 822 pasien yang tersisa.0 ° C yang telah menerima imunisasi 2 hari sebelum presentasi. Dari 44 SBI. College Station. persetujuan itu diperoleh untuk 501 (61%) dari mereka. WBC nilai secara signifikan lebih tinggi di SBI dan kelompok RI saat dibandingkan dengan kelompok NRI. usia rata-rata dari pasien dalam kelompok RI secara signifikan lebih tinggi dari dalam kelompok SBI dan NRI. Gambar 1 menggambarkan distribusi nilai procalcitonin di SBI. Pasien kedua adalah seorang anak 71-hari-tua yang telah menerima imunisasi sebelumnya hari itu dan disajikan dengan suhu 38.

103/_L 14. tidak responsif". 118 . spesifisitas adalah 23% (95% CI: 18% -29%).017 0. dan prediksi negatif nilai (NPV) adalah 96% (95% CI: 86% -99%).8) 13. Perhitungan ini dibatasi oleh ukuran sampel yang kecil dari 2 pasien dengan SBI dan imunisasi terakhir.3 (7.9 (0.001 _.6% (3 dari 35).org.50) 0.112 WBC. dan spesifisitas untuk non-SBI adalah 8. 9 Korczowski melaporkan pada kohort 17 pasien yang disajikan untuk keadaan darurat pediatrik departemen di Polandia dengan vaksinasi terkait merugikan peristiwa. Diberikan oleh Indonesia: AAP sponsor pada 12 Desember 2010 Tidak ada konsensus pada apakah untuk mengobati pasien berbeda dibandingkan dengan demam dan tidak ada sejarah baru-baru imunisasi. rata-rata (SD). Sebuah pencarian database Medline mengungkapkan hanya 1 artikel tentang tingkat procalcitonin setelah vaksinasi: dalam sebuah surat kepada editor dari Pediatric Infectious Penyakit Journal." pengoles E1120 dkk Download dari www.133 0.18-0.pediatrics.29 (0. kepekaan procalcitonin untuk SBI adalah 100% (2 dari 2).46) .8 (4.001 Procalcitonin. Tabel 1 Perbandingan Subkelompok Studi Kelompok SBI (N_44) Kelompok RI (N_35) NRI Kelompok (N_192) P SBI SBI vs vs RI NRI RI vs NRI Umur.17 (0.5 ° C. median (IQR).001 _.68) 38. Pengaruh vaksinasi pada tingkat procalcitonin telah belum diteliti dengan baik.8 Hal ini menimbulkan masalah unik dalam mereka bayi _3 bulan usia yang berisiko lebih tinggi memiliki SBI.2) . Menggunakan titik potong yang sama untuk 37 pasien yang telah menerima imunisasi dalam 48 jam terakhir (35 pada RI kelompok dan 2 dengan imunisasi terakhir di SBI kelompok).2 (4. ng / mL 0.207 .27) 0. beracun. rata-rata (SD).18-2. d 45 (25) 63 (7) 51 (23) 0. "sekarat.001 IQR menunjukkan kisaran interkuartil. Usia rata-rata bayi adalah 20 minggu . "yang sehat bayi.kohort adalah 96% (95% CI: 83% -99%).41) 0. median (IQR) dengan 4 (4-5) 5 (4-5) 4 (4-5) .6 (0. ° C 38.53) 38. Enam belas pasien memiliki suhu dari _38.32 Secara keseluruhan penampilan. skala Penampilan: 1. PEMBAHASAN Demam adalah yang paling sering dilaporkan "serius" dan "Nonserious" peristiwa buruk setelah imunisasi menurut untuk Event Vaksin Merugikan Pelaporan System. sakit muncul.7) 11. interaktif. rata-rata (SD).019 .7 (0.781 . 5.120.002 _.002 .001 Suhu tertinggi.53 (0.

WBC count. Oleh karena itu. Kita adalah sebuah studi kohort prospektif yang mencakup _90 271 hari tua dengan suhu didokumentasikan bayi dari _38 ° C dalam departemen darurat pediatrik. titik potong dari 0. mereka tanpa SBI yang telah baru-baru menerima imunisasi. tetapi masih dapat digunakan untuk mengidentifikasi kelompok berisiko rendah untuk SBI tanpa memandang status imunisasi. dan kemungkinan negatif rasio 0. Dalam studi saat ini. semua kasus bakteremia diidentifikasi secara akurat dengan titik cutnilai. dan NPV adalah 96% (95% CI: 86% -99%). kepekaan procalcitonin untuk SBI dalam seluruh kelompok adalah 96% (95% CI: 83% -99%). tingkat procalcitonin dapat melanjutkan yang akan digunakan untuk mengidentifikasi pasien yang beresiko rendah untuk SBI. Para WBC count juga meningkat pada kelompok RI saat dibandingkan dengan non-SBI pasien tanpa imunisasi terakhir tetapi mirip dengan mereka dengan SBI.74).(Rentang: 6-37 minggu). dan mereka tanpa SBI yang tidak baru saja menerima imunisasi. penambahan divaksinasi bayi ke dalam analisis kohort seluruh menyebabkan serupa sensitivitas dan NPV tetapi menurun kekhususan dari procalcitonin tingkat sebagai penanda SBI. kurang berguna untuk pasien yang baru menerima vaksinasi. Median tingkat procalcitonin secara signifikan lebih tinggi dalam kelompok bayi yang telah menerima imunisasi dibandingkan dengan mereka yang tidak. penanda umum digunakan untuk SBI.8 _ 0. spesifisitas 26% (95% CI: 20% -32%). Penelitian kami memiliki beberapa keterbatasan. NPV dari 96% (95% CI: 85% -99%).19 (95% CI: 0. Dalam kohort itu.9 ng / mL (kisaran: 0.12 ng / mL memiliki sensitivitas 95% (95% CI: 83% -99%). Korczowski menyimpulkan bahwa tingkat sederhana procalcitonin dapat meningkat setelah vaksinasi dengan tidak adanya infeksi. tetapi secara signifikan lebih rendah dibandingkan pada kelompok SBI. Atas dasar ini. Para procalcitonin serum rata-rata tingkat pada pasien ini adalah 0.12 ng / mL. kedua pasien di kami kohort dengan SBI yang baru menerima imunisasi diidentifikasi. Perubahan ini karena dari sebagian besar pasien diimunisasi memiliki procalcitonin nilai yang lebih besar dari titik potong kami dari 0. Secara keseluruhan. Tidak ada SBI. Kami dilaporkan sebelumnya utilitas tingkat procalcitonin untuk memprediksi SBI pada pasien yang tidak menerima imunisasi dalam 48 jam sebelumnya. Namun.1-3. dan dengan menggunakan titik potong yang sama. spesifisitas adalah 23% (95% CI: 18% -29%). tampaknya bahwa imunisasi menyebabkan peningkatan serum procalcitonin nilai-nilai. Penelitian dilakukan pada departemen darurat akademis pediatrik .05-0. Bila menggunakan memotong diterbitkan sebelumnya kami titik 0. kami lebih lanjut subcategorized yang pasien yang dengan SBI.12 ng / mL.6 ng / mL).

Nomor 5. Jr. Selain itu.5 kali IQR tersebut. Pediatri Volume 122. MD. dan kami mengucapkan terima kasih atas bantuan dan keahlian Richard Snider. November 2008 e1121 Download dari www. karenanya. Kami berterima kasih atas dukungan keuangan Frederick H. UCAPAN TERIMA KASIH Kami berterima kasih kepada rekan-rekan dokter di darurat departemen yang memfasilitasi pendaftaran untuk penelitian. tidak dapat memberikan rincian lebih lanjut tentang spesifik efek dari vaksin individu pada nilai-nilai procalcitonin. Kami mengakui bahwa beberapa pasien dengan rendah-koloni-hitungan UTI dan pneumonia radiografi mungkin tidak terwakili benar bakteri infeksi. untuk bekerja pada tes procalcitonin. karena kami berharap untuk mengidentifikasi kelompok berisiko rendah untuk SBI. BS. PhD. Diberikan oleh Indonesia: AAP sponsor pada 12 Desember 2010 Akhirnya. Selain itu. SBI RI NRI Studi subkelompok 5 4 3 2 1 0 Procalcitonin. Meskipun peningkatan ini. kita mengakui dukungan teknis . Lovejoy. dengan demikian. dan Robyn Neches. Studi awal kami menyediakan lanjut analisis terhadap SBI yang pasti dan mungkin untuk account ini kesulitan dalam definisi. bahkan di antara orang demam bayi yang baru-baru divaksinasi dan disajikan dengan demam. Residen Research Fund dan American Academy of Pediatrics Residen Penelitian Grant. KESIMPULAN Di antara bayi demam muda dengan imunisasi terakhir. Kumis mewakili 1. mungkin ada bias yang telah setiap evaluasi laboratorium.pediatrics. ng / mL GAMBAR 1 Perbandingan dari subkelompok studi. kami tidak mengumpulkan informasi tentang jenis vaksinasi yang diterima dan. Kotak mewakili batas dari persentil 25 dan 75 dan dibagi dengan garis di median.dan. definisi kami SBI yang dimaksudkan untuk menjadi konservatif untuk mencakup semua SBI mungkin. tidak dapat mewakili populasi yang lebih besar pasien setelah imunisasi. tingkat procalcitonin masih bisa dipercaya diskriminasi bayi dengan SBI. tingkat procalcitonin meningkat dibandingkan dengan pasien dengan demam dan tidak ada infeksi bakteri Selain itu.

especially of bacterial origin.1 Diagnosis and prognosis of sepsis 1. In serum. when compared with IL-2.terkait dengan pemrosesan spesimen oleh Klinis Umum Research Center di Rumah Sakit Anak Boston (Nasional Pusat Penelitian Sumber Daya. The level of procalcitonin in the blood stream of healthy individuals is below the limit of detection (10 pg/mL) of clinical assays. In this case. the latter being involved with calcium homeostasis. the blood levels of procalcitonin may rise to 100 ng/ml. IL-8. PCT has the greatest sensitivity (85%) and specificity (91%) for differentiating patients with SIRS from those with sepsis. With the derangements that a severe infection with an associated systemic response brings. It does not raise significantly with viral or non-infectious inflammations. Organisasi pendanaan tidak peran dalam desain. Contents [hide] • 1 Uses 1.2 Diagnosis of bacteremia 1.[3] Evidence is emerging that procalcitonin levels can . It is composed of 116 amino acids and is produced by parafollicular cells (C cells) of the thyroid and by the neuroendocrine cells of the lung and the intestine. atau persiapan naskah. Anak-Anak Rumah Sakit Umum Boston Klinis Pusat Penelitian terlibat dalam pengolahan sampel. IL-6.[1] The level of procalcitonin raises in a response to a proinflammatory stimulus. procalcitonin has a half-life of 25 to 30 hours. CRP and TNF-alpha. Remarkably the high procalcitonin levels produced during infections are not followed by a parallel increase in calcitonin or serum calcium levels. Institut Kesehatan Nasional hibah M01RR02172). analisis data. PROCALCITONIN Procalcitonin (PCT) is a peptide precursor of the hormone calcitonin. it is produced mainly by the cells of the lung and the intestine.3 Prognosis of pneumonia 2 References o o o • • 3 External links [edit] Uses [edit] Diagnosis and prognosis of sepsis Measurement of procalcitonin can be used as a marker of severe sepsis and generally grades well with the degree of sepsis.[2] although levels of procalcitonin in the blood are very low. Penelitian Klinis Umum Pusat Program.

" Inclusion criteria were expected length of ICU stay of more than 3 days. respectively".[7] However.[8] Procalcitonin levels may be useful to distinguish bacterial infections from nonbacterial infections. MD. France. In this trial.[4] Currently. Hôpital Bichat–Claude-Bernard. prognostic value" of procalcitonin measurement.25 mcg/L) or encouraged (> or =0. and colleagues from the PRORATA trial group. observational study reported "limited. Use of blood procalcitonin concentration to guide antibiotic use has been associated with markedly less antibiotic prescriptions in patients seen in the emergency department or hospitalized for lower respiratory tract infections. procalcitonin assays are widely used in the clinical environment. 2010 — A procalcitonin-guided strategy to treat suspected bacterial infections in nonsurgical patients in intensive care units (ICUs) may safely reduce antibiotic exposure and selective pressure. Procalcitonin May Help Guide Antibiotic Use in Intensive Care Units January 27. "We aimed to establish the effectiveness of an algorithm based on the biomarker procalcitonin to reduce antibiotic exposure in this setting. and age 18 years or older. Trials from 2008 and 2009 have shown that they may help guide therapy and reduce antibiotic use. suspected bacterial infection.1 mcg/L or <0. Procalcitonin is a calcitonin precursor hormone thought to be a fairly specific marker for severe bacterial infection in patients with suspected sepsis." write Lila Bouadma.5 mcg/L or > or =0. Assistance PubliqueHôpitaux de Paris in Paris. which can help save on cost of antibiotic prescriptions and drug resistance. Patients were randomly assigned in a 1:1 ratio to receive procalcitonin (n = 311) or to a control group (n = 319) with use of . "on the basis of serum procalcitonin concentrations.[6] [edit] Prognosis of pneumonia A cluster randomized trial found that the procalcitonin level can help guide antibiotic therapy. parallel-group.25 mcg/L).[5] [edit] Diagnosis of bacteremia A meta-analysis reported a sensitivity of 76% and specificity of 70%. from Université Paris 7–Denis-Diderot. "Reduced duration of antibiotic treatment might contain the emergence of multidrugresistant bacteria in intensive care units. use of antibiotics was more or less discouraged (<0. an earlier nonrandomized.reduce unnecessary antibiotic prescribing to people with lower respiratory tract infections. open-label trial reported online January 23 in The Lancet. prospective. according to the results of a multicenter.

the procalcitonin group had apparently noninferior mortality at day 28 (21. The main study outcomes were mortality at days 28 and 60 (noninferiority analysis) and number of days without antibiotics by day 28 (superiority analysis). 95% CI – 2.7 days. the procalcitonin group also had significantly more days without antibiotics (14.6 ± 8. MD.2 days. nasal. Marin H. "We stress that infection is the tip of the iceberg compared with digestive colonisation. computer-generated randomization sequence. from Washington University School of Medicine in St." the study authors write. including those who are immunocompromised.4% [64/314]. with use of a 10% margin of noninferiority.2) and day 60 (30. and definitions of relapse and superinfection based on microbiological criteria. a 3-day reduction of antibiotic use for only a small subset of admitted patients might not be sufficient to record a decreased resistance-emergence rate." In an accompanying comment. In the control group. P < . absolute difference." Dr.8%.0001).4. inability to extrapolate the findings to surgical patients." . absolute difference.1 days vs 11.7). After exclusion of 9 patients. On the basis of predefined cutoff ranges of procalcitonin concentrations. "Rectal.3 ± 9. 2. 1. 95% CI. 3. antibiotics were prescribed according to current guidelines. "A procalcitonin-guided strategy to treat suspected bacterial infections in non-surgical patients in intensive care units could reduce antibiotic exposure and selective pressure with no apparent adverse outcomes.8%. analyses included 307 patients in the procalcitonin group and 314 in the control group. discusses treatment bias and other potential limitations of this study. "Experience so far suggests that unnecessary antibiotic use can be curtailed in the hospital setting.0% [92/307] vs 26. lack of algorithm-guided treatment in more than half of patients randomly assigned to the procalcitonin independent. The treating physician controlled drug selection and the final decision to start or stop antibiotics. antibiotics were started or stopped for patients in the procalcitonin group. especially for some intensive care units with high cross-transmission rates. "The diverse clinical characteristics and reasons for admissions to the intensive care unit for patients enrolled in this study suggest that our conclusions could be applicable to most nonsurgical patients in the intensive care unit. FACP. –4.6 to 6. and axillary swab screening was not routinely done and might more accurately show antibiotic selective pressure. 90% confidence interval [CI]. Kollef writes.1. Kollef. Missouri." the study authors conclude. Compared with the control group. Louis." Limitations of this study include open design. "Whether the ideal strategy involves the use of a serum marker such as procalcitonin or a locally applied practice protocol remains to be established. Compared with the control group. particularly within intensive care units.1% [82/314]. The investigators were blinded to assignment before randomization but not subsequently. absolute difference.2% [65/307] vs 20.4 . Moreover.1 to 9. Analyses were by intentto-treat. 0.

Among these. Thus. heart rate. and to predict prognosis of critically ill patients (2). Sepsis is diagnosed retrospectively with knowledge of bacterial cultures and a full clinical picture in most studies. Merck Sharp & Dohme-Chibret. Janssen-Cilag. few studies have addressed the utility of PCT to predict sepsis in “real time”. Lancet. Wyeth. both medical and surgical (1). Published online January 23. France. These SIRS criteria are non-specific for sepsis and may be present in alternative pathophysiologic states. respiratory rate. 2010. Pfizer. AstraZeneca. Germany supported this study. Arpida. Elevated PCT is seen in septic patients and concentrations correlate with severity of disease.Assistance Publique-Hôpitaux de Paris. Two meta-analyses recommend routine use of PCT for diagnosis of sepsis while two others discourage its use (3-6). trauma. A biomarker that could identify sepsis early in a population of patients with overlapping clinical symptoms. while decreasing concentrations correlate to good prognosis and/or response to antibiotic Sepsis is systemic inflammation due to infection. i. and/or AstraZeneca. Increasing PCT over time is associated with poor prognosis. and/or white blood cell count. Kollef has disclosed no relevant financial relationships. or in other instances of systemic inflammation limiting its diagnostic accuracy. Most randomized control trials demonstrate that using serial PCT based algorithms to guide continuation/cessation of antibiotic therapy reduces the number of days patients are on antibiotics without adverse effects. Procalcitonin: an early predictor of sepsis? Thousands of studies have investigated the clinical utility of almost 200 biomarkers of sepsis (3). Does PCT have a role in tailoring antibiotic therapy? Overuse of antibiotics in ICU settings has contributed to the increase in antibiotic resistant bacteria. Different PCT cut-offs are used. and Brahms. but sensitivity and specificities to predict sepsis are <90% for both markers. Cultures take at least 24 hours and > 50% may be false negative and 30% false positive. Currently diagnosis involves documentation of infection (by culture) in patients with SIRS. Some of the study authors have disclosed various financial relationships with Brahms. PCT and CRP are most often referenced. Sepsis can be considered in individuals with systemic inflammatory response syndrome (SIRS) manifested by alterations in at least two of temperature.medscape. Many suggest that Procalcitonin (PCT) is an ideal sepsis biomarker. Johnson & Johnson. PCT is the pro-hormone form of calcitonin and is produced by extra-thyroidal immune cells within 2-4 hours of a bacterial insult and/or inflammatory response. http://www.e. Why the discrepancy? Lack of a gold standard for sepsis diagnosis. The earlier sepsis is identified and treated the better the prognosis (1). To date. PCT consistently performs better. proponents suggest that the clinical utilities of PCT are: to differentiate patients with sepsis from those with non-infectious SIRS. None has demonstrated a reduction in multidrug . patient’s with non-infectious SIRS would improve patient care. to guide antibiotic therapy. Until. Gilead. In comprehensive reviews comparing their diagnostic accuracies. Diverse patient populations--PCT is elevated postsurgery. It is the most common cause of death in intensive care units (1). Dr. with a mortality rate up to 50% depending on severity. Lilly. Nektar-Bayer. large real time studies with well defined patient populations are completed. the utility of PCT to predict sepsis will remain controversial.

there is limited utility for PCT to guide initiation of antimicrobial therapy because most ICU patients are taking antibiotics at admission. surgery or other inflammatory event (6). In practice. PCT based algorithms for guiding antibiotic therapy are limited to guiding secession/continuation of therapy in non-surgical/trauma ICU patients. Most studies exclude patients with a recent trauma. Can procalcitonin be used to predict prognosis? Increasing PCT concentrations correlate with increasing severity of sepsis and poor outcome.resistant (MDR) bacterial infections (7). http://www. serial PCT measurements may be cost prohibitive if no reduction in MDR infections is Thus. Further.aspx?ID=16 . these algorithms are not effective in patients with recent trauma. it may be that no one biomarker works for sepsis. surgery or other global inflammation. Studies looking at multibiomarker panels have shown promise in the prediction and monitoring of sepsis in ICU and ED patients (3). And even in these populations. Given the complicated pathobiology of sepsis and significant overlap in clinical symptoms with SIRS patients. while decreasing or low PCT predicts a good prognosis for ICU patients.aacc.

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