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Abstract
Empirical antibiotic use is prescribed in managing children with pneumonia worldwide. We assessed the usefulness of procalcitonin (PCT) and interferon-alpha (IFN-α) in differentiating viral from bacterial pneumonia. Among 159 hospitalized children, pneumonia was diagnosed based on clinical complaints plus pulmonary infiltrate. Aetiology was investigated for 9 viruses and 4 atypical and 3 typical bacteria. PCT and IFN-α were measured in the serum sample collected on admission. Eight patients had bacteraemic infections, 38 had non-bacteraemic typical infections, and 19 patients had atypical bacterial infections. Viral and unknown aetiology was established in 57 (36%) and 34 (21%) cases, respectively. Three patients with bacterial infection without collected blood culture were excluded. IFN-α (IU/ml) was detectable in 20 (13%) cases. The difference among median PCT values of the bacteraemic (4.22; 1.56–7.56), non-bacteraemic typical bacterial (1.47; 0.24–4.07), atypical bacterial (0.18; 0.06–1.03) and only viral (0.65; 0.11–2.22) subgroups was significant (p = 0.02). PCT was ≥2 ng/ml in 52 (33%) cases. The presence of IFN-α was associated with PCT <2 ng/ml (90% vs. 64%, p = 0.02). The negative predictive value (95% confidence interval) of PCT ≥2 ng/ml was 95% (89–100%), 89% (78–100%), 93% (85–100%) for differentiation of bacteraemic from viral, atypical bacterial and non-bacteraemic typical bacterial infection, respectively, and 58% (49–68%) for differentiation between bacterial and viral infection. PCT may be useful in identifying bacteraemia among children hospitalized with community-acquired pneumonia. IFN-α was uncommonly detected.
Acknowledgements
This study was supported by funding from the Fundação de Amparo à Pesquisa no Estado da Bahia (FAPESB), Salvador, Brazil and the Paediatric Research Foundation, Helsinki, Finland. C.M.N.-C., M.-R.A.C. and A.B. are investigators of the Brazilian Council for Science and Technology Development (CNPq).
Ethics statement: The study protocol was approved by the Ethics Committee of the Federal University of Bahia and by the Brazilian National Research Ethics Committee. Informed consent was obtained before study enrolment.
Declaration of interest: No conflict of interest to declare.