Abstract
Aims & Objectives: Inflammatory biomarkers have been used to guide antibiotic duration in adults and neonates, but their utility in children admitted to pediatric intensive care units (PICUs) is unknown. Our objective was thus to characterize the temporal behaviour of biomarkers (C-reactive protein [CRP], procalcitonin, and white blood cell [WBC] count) in children with severe bacterial infections. Methods: Ongoing prospective cohort study in 7 Canadian PICUs including patients 1 month to 18 years old admitted with suspected or proven severe bacterial infection (sepsis, pneumonia, and central nervous system and intrabdominal infections) and who were prescribed ≥1 antimicrobial. We measure biomarker levels from days 1 to 7 and day 10 of antibiotic treatment. We used Pearson’s correlation coefficient and multivariable linear regressions. Results: We have enrolled 208 patients. Median age was 56.0 months (interquartile range [IQR] 14.8 – 103.0). Median antibiotic duration was 9.5 days (IQR 6.0 – 14.0). Absolute levels of CRP and procalcitonin were highest on day 1 and descended over the course of treatment. By day 5, 82% and 43% of patients had ≥80% drop in procalcitonin and CRP levels, respectively. Patients with ≥50% drop in CRP from days 1 to 3 had a shorter hospital stay (-6.4 days, 95% confidence interval [CI] -12.2, -0.8). There was a strong correlation between mean daily values of multiple organ dysfunction syndrome scores with mean daily CRP (0.93, 95%CI 0.66, 0.99) and procalcitonin values (0.98, 95%CI 0.88, 0.99).Conclusions: Preliminary data suggest that CRP and procalcitonin may be good candidate biomarkers to personalize antibiotic treatment duration in children.
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