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Richard Bachur, MD |
Testing serum levels of procalcitonin may help detect serious bacterial infections (SBIs) in infants under 3 months of age presenting with fever, finds a study led by Richard Bachur, MD, acting chief of Children's Hospital Boston's Division of Emergency Medicine, in collaboration with George Washington University (Pediatrics, October 2008).
Infant fever accounts for the vast majority of pediatric visits to emergency rooms in the United States, with up to 20 percent of cases having no identifiable cause of infection. While most illnesses turn out to be minor, some infants have SBIs, such as bacteremia, meningitis or urinary tract infections. Because clinicians cannot reliably determine which children have these more serious infections and which do not, many babies end up undergoing extensive evaluations that can include lumbar puncture and hospitalization.
Seeking a rapid diagnostic test to identify children with serious infections at first presentation, Dr. Bachur and colleagues used a novel procalcitonin assay, recently approved by the FDA, in 234 feverish babies under 3 months old. Eighteen percent of these infants had definite or possible SBIs confirmed by strict clinical criteria. The procalcitonin assay not only detected all cases of SBI in febrile infants, it also proved sensitive enough to establish a threshold value that could identify infants at low risk for SBIs. Indeed, the test's overall performance as a single clinical marker of infection approached that of current strategies, which involve a
variety of laboratory tests and clinical evaluations.
In a separate study, Dr. Bachur examined vaccination-induced fever as a possible confounder and showed
that procalcitonin levels remain a reliable marker even in recently vaccinated young infants. Dr. Bachur hopes the test will eventually become a standard tool for evaluating febrile infants for serious
infectious conditions and spare babies at low risk for SBIs
unnecessary testing, medication and hospitalization (Pediatrics, November 2008). |
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