Procalcitonin is not sufficiently reliable to be the sole marker of neonatal sepsis of nosocomial origin

被引：0

作者：

López Sastre J.B. ^{[1
]}

Pérez Solís D. ^{[1
]}

Roqués Serradilla V. ^{[2
]}

Fernández Colomer B. ^{[1
]}

Coto Cotallo G.D. ^{[1
]}

Krauel Vidal X. ^{[3
]}

Narbona López E. ^{[4
]}

García del Río M. ^{[5
]}

Sánchez Luna M. ^{[6
]}

Belaustegui Cueto A. ^{[7
]}

Moro Serrano M. ^{[8
]}

Urbón Artero A. ^{[9
]}

Álvaro Iglesias E. ^{[10
]}

Cotero Lavin A. ^{[11
]}

Martínez Vilalta E. ^{[12
]}

Jimenez Cobos B. ^{[13
]}

机构：

[1] Service of Neonatology, Hospital Universitario Central de Asturias, Oviedo

[2] Service of Neonatology, Hospital Universitario La Fe, Valencia

[3] Service of Neonatology, Hospital Sant Joan de Déu, Barcelona

[4] Service of Neonatology, Hospital Universitario San Cecilio, Granada

[5] Service of Neonatology, Hospital Regional Universitario Carlos Haya, Málaga

[6] Service of Neonatology, Hospital Universitario Gregorio Marañón, Madrid

[7] Service of Neonatology, Hospital Universitario Doce de Octubre, Madrid

[8] Service of Neonatology, Hospital Clínico San Carlos, Madrid

[9] Service Pediatrics, Complejo Hospitalario de la Seguridad Social, Segovia

[10] Service Pediatrics, Hospital de León, León

[11] Service of Neonatology, Hospital de Cruces, Barakaldo

[12] Service of Neonatology, Hospital Universitario Virgen de la Arrixaca, Murcia

[13] Service of Neonatology, Hospital General Universitario de Alicante, Alicante

来源：

BMC Pediatrics | / 6卷 / 1期

关键词：

Systemic Inflammatory Response Syndrome; Vertical Transmission; Procalcitonin; Neonatal Sepsis; Peripheral Blood Culture;

D O I：

10.1186/1471-2431-6-16

中图分类号：

学科分类号：

摘要：

Background: It has recently been suggested that serum procalcitonin (PCT) is of value in the diagnosis of neonatal sepsis, with varying results. The aim of this prospective multicenter study was to assess the usefulness of PCT as a marker of neonatal sepsis of nosocomial origin. Methods: One hundred infants aged between 4 and 28 days of life admitted to the Neonatology Services of 13 acute-care teaching hospitals in Spain over 1-year with clinical suspicion of neonatal sepsis of nosocomial origin were included in the study. Serum PCT concentrations were determined by a specific immunoluminometric assay. The reliability of PCT for the diagnosis of nosocomial neonatal sepsis at the time of suspicion of infection and at 12-24 h and 36-48 h after the onset of symptoms was calculated by receiver-operating characteristics (ROC) curves. The Youden's index (sensitivity + specificity - 1) was used for determination of optimal cutoff values of the diagnostic tests in the different postnatal periods. Sensitivity, specificity, and the likelihood ratio of a positive and negative result with the 95% confidence interval (CI) were calculated. Results: The diagnosis of nosocomial sepsis was confirmed in 61 neonates. Serum PCT concentrations were significantly higher at initial suspicion and at 12-24 h and 36-48 h after the onset of symptoms in neonates with confirmed sepsis than in neonates with clinically suspected but not confirmed sepsis. Optimal PCT thresholds according to ROC curves were 0.59 ng/mL at the time of suspicion of sepsis (sensitivity 81.4%, specificity 80.6%); 1.34 ng/mL within 12-24 h of birth (sensitivity 73.7%, specificity 80.6%), and 0.69 ng/mL within 36-48 h of birth (sensitivity 86.5%, specificity 72.7%). Conclusion: Serum PCT concentrations showed a moderate diagnostic reliability for the detection of nosocomial neonatal sepsis from the time of suspicion of infection. PCT is not sufficiently reliable to be the sole marker of sepsis, but would be useful as part of a full sepsis evaluation. © 2006 Sastre et al; licensee BioMed Central Ltd.

引用

共 28 条

[1]

Peter G., Cashore W.J., Infections acquired in the nursery: Epidemiology and control, Infectious Diseases of the Fetus and Newborn Infant, pp. 1264-1283, (2001)

[2]

Lopez Sastre J.B., Coto Cotallo D., Fernandez Colomer B., Grupo de Hospitales Castrillo: Neonatal sepsis of nosocomial origin: An epidemiological study from the "Grupo de Hospitales Castrillo, J Perinat Med, 30, pp. 149-157, (2002)

[3]

Polin R.A., The "ins and outs" of neonatal sepsis, J Pediatr, 143, pp. 3-4, (2003)

[4]

Weinberg G.A., Powell K.R., Laboratory aids for diagnosis of neonatal sepsis, Infectious Diseases of the Fetus and Newborn Infant, pp. 1327-1344, (2001)

[5]

Muller B., White J.C., Nylen E.S., Snider R.H., Becker K.L., Habener J.F., Ubiquitous expression of the calcitonin-i gene in multiple tissues in response to sepsis, J Clin Endocrinol Metab, 86, pp. 396-404, (2001)

[6]

Gendrel D., Bohuon C., Procalcitonin as a marker of bacterial infection, Pediatr Infect Dis J, 19, pp. 679-687, (2000)

[7]

Ballot D.E., Perovic O., Galpin J., Cooper P.A., Serum procalcitonin as an early marker of neonatal sepsis, S Afr Med J 2004, 94, pp. 851-854

[8]

Blommendahl J., Janas M., Laine S., Miettinen A., Ashorn P., Comparison of procalcitonin with CRP and differential white blood cell count for diagnosis of culture-proven neonatal sepsis, Scand J Infect Dis, 34, pp. 620-622, (2002)

[9]

Chiesa C., Panero A., Rossi N., Stegagno M., De Giusti M., Osborn J.F., Pacifico L., Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates, Clin Lnfect Dis, 26, pp. 664-672, (1998)

[10]

Chiesa C., Pellegrini G., Panero A., Osborn J.F., Signore F., Assumma M., Pacifico L., C-reactive protein, interleukin-6, and procalcitonin in the immediate postnatal period: Influence of illness severity, risk status, antenatal and perinatal complications, and infection, Clin Chem, 49, pp. 60-68, (2003)

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