Abstract
Objective(s): Blood cultures (BC), when performed in children seen in the emergency department with community-acquired pneumonia (CAP), are most of the time sterile. We described the diagnostic accuracy of white blood cells (WBC), absolute neutrophils count (ANC), C-reactive protein (CRP), and procalcitonin (PCT) to predict blood culture (BC) result in childhood CAP.Study Design: Secondary analysis of a prospective study carried out in eight pediatric emergency departments (France, 2009–2018), including children (≤15 years) with CAP. Analyses involved univariate comparisons and ROC curves.Results: We included 13,752 children with CAP. BC was positive in 137 (3.6%) of the 3,829 children (mean age 3.7 years) in whom it was performed, mostly with Streptococcus pneumoniae (n = 107). In children with bacteremia, ANC, CRP and PCT levels were higher (median 12,256 vs. 9,251/mm3, 223 vs. 72 mg/L and 8.6 vs. 1.0 ng/mL, respectively; p ≤ 0.002), but WBC levels were not. The area under the ROC curve of PCT (0.73 [95%CI 0.64–0.82]) was significantly higher (p ≤ 0.01) than that of WBC (0.51 [0.43–0.60]) and of ANC (0.55 [0.46–0.64]), but not than that of CRP (0.66 [0.56–0.76]; p = 0.21). CRP and PCT thresholds that provided a sensitivity of at least 90% were 30 mg/L and 0.25 ng/mL, respectively, for a specificity of 25.4 and 23.4%, respectively. CRP and PCT thresholds that provided a specificity of at least 90% were 300 mg/L and 20 ng/mL, respectively, for a sensitivity of 31.3 and 28.9%, respectively.Conclusions: PCT and CRP are the best routinely available predictive biomarkers of bacteremia in childhood CAP.
Highlights
With 120–150 million new cases each year in the world, including around 14 million severe episodes, childhood communityacquired pneumonia (CAP) is a major public health issue
We described the diagnostic accuracy of white blood cells (WBC), absolute neutrophils count (ANC), C-reactive protein (CRP), and procalcitonin (PCT) to predict blood culture (BC) result in childhood CAP
Biomarkers in Community-Acquired Pneumonia curve of PCT (0.73 [95% confidence interval (95%CI) 0.64–0.82]) was significantly higher (p ≤ 0.01) than that of WBC (0.51 [0.43–0.60]) and of ANC (0.55 [0.46–0.64]), but not than that of CRP (0.66 [0.56–0.76]; p = 0.21)
Summary
With 120–150 million new cases each year in the world, including around 14 million severe episodes, childhood communityacquired pneumonia (CAP) is a major public health issue. In 2015, CAP caused about 16% of all deaths in children under 5 years old, which represents 920,136 deaths according to the World Health Organization, with the major burden of the disease being carried by children from low- and middle-income countries [1, 2]. In young children under 10 years, non-invasive microbiological testing such as pneumococcal urinary antigen may indicate carriage rather than true infection [5]. High levels of white blood cells (WBC), absolute neutrophils count (ANC), and C-reactive protein (CRP) are usually considered associated with bacterial disease. European and North-American guidelines recommend empirical antibiotic treatment based on the assessment of epidemiological factors and clinical severity rather than laboratory and imaging testing [8, 9]
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