Procalcitonin as a Marker of Bacteremia in Children With Fever and a Central Venous Catheter Presenting to the Emergency Department

Abstract

To evaluate the clinical use of procalcitonin (PCT) as a rapid marker for the identification of bacteremia in the emergency department (ED) population of children with fever and a central venous catheter (CVC). Children were identified on presentation to the ED with a chief complaint of fever and who had a CVC. Fever was defined as 38°C or higher orally. Patients were excluded from the study if they had received antibiotics within the previous 24 hours of presenting to the ED, if they had a peripherally inserted central catheter line or by parental refusal. On presentation to the ED, all patients had a complete blood cell count with differential, blood culture from the central line, and PCT levels drawn. All had empiric antibiotics initiated. Blood culture results were recorded, and in the case of positive cultures, time to positive culture was noted. Sixty-two patients (aged 5 months-18 y) were enrolled, and 14 (23%) had a positive culture. Mean PCT value in bacteremic patients was 18.47 ± 31.6 ng/mL and 0.65 ± 1.2 ng/mL in nonbacteremic patients (P < 0.001). Median PCT for negative blood culture was 0.23 ng/mL (interquartile range, 0.11-0.61) and 1.15 ng/mL for a positive blood culture (interquartile range, 0.45-29.16). The receiver operating characteristic analysis identified a level of PCT of 0.3 ng/mL as the best cutoff point that produced a sensitivity of 93% and a specificity of 63% (area under the curve, 0.82). The PCT levels are useful in identifying children with fever and a CVC who are bacteremic in the ED.