THE UTILITY OF PROCALCITONIN IN THE PREDICTION OF SERIOUS BACTERIAL INFECTION IN A TERTIARY PEDIATRIC INTENSIVE CARE UNIT
Matha SM, Rahiman SN, Gelbart BG, Dukes TD. Anaesth Intensive Care. 2016;44(5):607-614.
Procalcitonin (PCT) has been investigated as a biomarker of sepsis because PCT levels are quick to rise (6-12) hours after an infection develops and fall in concentration within 24 hours of control of the infection. There has been limited investigation in the pediatric intensive care unit (PICU). The authors in this study sought to establish predictive thresholds for bacteremia to determine whether PCT distinguishes bacterial from viral infection and to compare the predictive power of PCT with the immature-to-total neutrophil ratio in peripheral blood (ITR).
Serum PCT concentrations were measured during a 13-month period among 420 children with suspected sepsis, with 1226 serum samples analyzed. Children with bacteremia had a higher median PCT (2.03 ng/mL) than those who did not have bacteremia (0.82 ng/mL). Procalcitonin was a significant but moderate predictor of bacteremia. In 866 episodes of suspected bacteremia, with paired PCT and ITR, it was found that PCT was a marginally better predictor of bacteremia than the ITR. In children with viral respiratory tract infection only, the median PCT was 1.26 ng/mL, and in those with likely bacterial pneumonia, the PCT was 0.80 ng/mL.
The authors concluded that, in a heterogeneous population, PCT measured at a single point in time was a moderate predictor of proven bacteremia. They also concluded that, in their population, PCT did not reliably identify or distinguish bacterial from viral respiratory infection.
COMPARING ADMINISTRATIVE AND CLINICAL DATA FOR CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTIONS IN PEDIATRIC INTENSIVE CARE UNIT AND PEDIATRIC CARDIOTHORACIC INTENSIVE CARE UNIT
Bond J, Issa M, Nasrallah A, Bahrolommi S, Blackwood RA. Infect Dis Rep. 2016;8(6275):58-62.
The aim of this retrospective chart review study was to determine the accuracy of coding for central line-associated bloodstream infections (CLABSIs)-a frequent source of complications for all patients-with the use of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Seventy-five charts were reviewed for PICUs and pediatric cardiothoracic intensive care units, with 90 events of hospital-acquired central line infections.
The researchers used the type of central line the patient had, the duration of the stay of the line, the type of organism infecting the patient, and the treatment the patient received as variables. A review was conducted to see whether the patients received the proper ICD-9-CM code for their hospital-acquired infection. The review found that, in most CLABSI cases, the hospitals' administrative data diagnosis using the ICD-9-CM system did not code for CLABSI. The researcher found a low sensitivity of 32% in the PICU and 12% in the pediatric cardiothoracic intensive care unit. The authors concluded that the ICD-9-CM cannot be used for accuracy defining hospital-acquired CLABSIs. They also concluded that, with the use of the new ICD-10CM coding system, further research is needed to assess the effects of coding CLABSI for the accuracy of administrative data.