Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009–2018
Objective(s): Blood cultures (BC), when performed in children seen in the emergency department with community-acquired pneumonia (CAP), are most of the time sterile. We described the diagnostic accuracy of white blood cells (WBC), absolute neutrophils count (ANC), C-reactive protein (CRP), and proca...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-10-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2021.684628/full |
| _version_ | 1819026218880598016 |
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| author | Danaé Dudognon Corinne Levy Corinne Levy Corinne Levy Corinne Levy Martin Chalumeau Martin Chalumeau Sandra Biscardi Sandra Biscardi Marie-Aliette Dommergues Marie-Aliette Dommergues François Dubos François Dubos Karine Levieux Karine Levieux Marie Aurel Marie Aurel Philippe Minodier Philippe Minodier Ferielle Zenkhri Ferielle Zenkhri Ellia Mezgueldi Ellia Mezgueldi Irina Craiu Irina Craiu Laurence Morin Laurence Morin Stéphane Béchet Emmanuelle Varon Robert Cohen Robert Cohen Robert Cohen Robert Cohen Robert Cohen Jérémie F. Cohen Jérémie F. Cohen The Pneumonia Study Group François Angoulvant Yves Gillet Christèle Gras-Le Guen Isabelle Hau Laure Hees Elise Launay Mathie Lorrot Fouad Madhi Alain Martinot Naim Ouldali |
| author_facet | Danaé Dudognon Corinne Levy Corinne Levy Corinne Levy Corinne Levy Martin Chalumeau Martin Chalumeau Sandra Biscardi Sandra Biscardi Marie-Aliette Dommergues Marie-Aliette Dommergues François Dubos François Dubos Karine Levieux Karine Levieux Marie Aurel Marie Aurel Philippe Minodier Philippe Minodier Ferielle Zenkhri Ferielle Zenkhri Ellia Mezgueldi Ellia Mezgueldi Irina Craiu Irina Craiu Laurence Morin Laurence Morin Stéphane Béchet Emmanuelle Varon Robert Cohen Robert Cohen Robert Cohen Robert Cohen Robert Cohen Jérémie F. Cohen Jérémie F. Cohen The Pneumonia Study Group François Angoulvant Yves Gillet Christèle Gras-Le Guen Isabelle Hau Laure Hees Elise Launay Mathie Lorrot Fouad Madhi Alain Martinot Naim Ouldali |
| author_sort | Danaé Dudognon |
| collection | DOAJ |
| description | Objective(s): Blood cultures (BC), when performed in children seen in the emergency department with community-acquired pneumonia (CAP), are most of the time sterile. We described the diagnostic accuracy of white blood cells (WBC), absolute neutrophils count (ANC), C-reactive protein (CRP), and procalcitonin (PCT) to predict blood culture (BC) result in childhood CAP.Study Design: Secondary analysis of a prospective study carried out in eight pediatric emergency departments (France, 2009–2018), including children (≤15 years) with CAP. Analyses involved univariate comparisons and ROC curves.Results: We included 13,752 children with CAP. BC was positive in 137 (3.6%) of the 3,829 children (mean age 3.7 years) in whom it was performed, mostly with Streptococcus pneumoniae (n = 107). In children with bacteremia, ANC, CRP and PCT levels were higher (median 12,256 vs. 9,251/mm3, 223 vs. 72 mg/L and 8.6 vs. 1.0 ng/mL, respectively; p ≤ 0.002), but WBC levels were not. The area under the ROC curve of PCT (0.73 [95%CI 0.64–0.82]) was significantly higher (p ≤ 0.01) than that of WBC (0.51 [0.43–0.60]) and of ANC (0.55 [0.46–0.64]), but not than that of CRP (0.66 [0.56–0.76]; p = 0.21). CRP and PCT thresholds that provided a sensitivity of at least 90% were 30 mg/L and 0.25 ng/mL, respectively, for a specificity of 25.4 and 23.4%, respectively. CRP and PCT thresholds that provided a specificity of at least 90% were 300 mg/L and 20 ng/mL, respectively, for a sensitivity of 31.3 and 28.9%, respectively.Conclusions: PCT and CRP are the best routinely available predictive biomarkers of bacteremia in childhood CAP. |
| first_indexed | 2024-12-21T05:23:05Z |
| format | Article |
| id | doaj.art-8ea93386307941a2bc8d0500fafe4ea8 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-21T05:23:05Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-8ea93386307941a2bc8d0500fafe4ea82022-12-21T19:14:45ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602021-10-01910.3389/fped.2021.684628684628Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009–2018Danaé Dudognon0Corinne Levy1Corinne Levy2Corinne Levy3Corinne Levy4Martin Chalumeau5Martin Chalumeau6Sandra Biscardi7Sandra Biscardi8Marie-Aliette Dommergues9Marie-Aliette Dommergues10François Dubos11François Dubos12Karine Levieux13Karine Levieux14Marie Aurel15Marie Aurel16Philippe Minodier17Philippe Minodier18Ferielle Zenkhri19Ferielle Zenkhri20Ellia Mezgueldi21Ellia Mezgueldi22Irina Craiu23Irina Craiu24Laurence Morin25Laurence Morin26Stéphane Béchet27Emmanuelle Varon28Robert Cohen29Robert Cohen30Robert Cohen31Robert Cohen32Robert Cohen33Jérémie F. Cohen34Jérémie F. Cohen35The Pneumonia Study GroupFrançois AngoulvantYves GilletChristèle Gras-Le GuenIsabelle HauLaure HeesElise LaunayMathie LorrotFouad MadhiAlain MartinotNaim OuldaliDepartment of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, FranceAssociation Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, FranceClinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, FranceParis Est University, IMRB-GRC GEMINI, Créteil, FranceDepartment of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, FranceEpidemiology and Statistics Research Centre - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Université de Paris, Paris, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, FrancePediatric Emergency Department, Centre Hospitalier Intercommunal de Créteil, Créteil, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, FranceDepartment of General Pediatrics, Centre Hospitalier de Versailles-Le Chesnay, Versailles, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, FrancePediatric Emergency Unit and Infectious Diseases, Univ. Lille, CHU Lille, Lille, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France0Department of Pediatrics, Centre Hospitalier Universitaire de Nantes, Nantes, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France1Department of General Pediatrics, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France2Pediatric Emergency Department, Centre Hospitalier Universitaire Nord, Marseille, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France3Pediatric Emergency Department, AP-HP, Hôpital Le Kremlin-Bicêtre, Université Paris Sud, Bicêtre, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France4Pediatric Emergency Department, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Lyon, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France3Pediatric Emergency Department, AP-HP, Hôpital Le Kremlin-Bicêtre, Université Paris Sud, Bicêtre, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France5Pediatric Emergency Department, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, FranceAssociation Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France6Centre National de Référence des Pneumocoques, Centre Hospitalier Intercommunal de Créteil, Créteil, FranceAssociation Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, FranceGroupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, FranceClinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, FranceParis Est University, IMRB-GRC GEMINI, Créteil, France7Service des Petits Nourrissons, Centre Hospitalier Intercommunal de Créteil, Créteil, FranceDepartment of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, FranceEpidemiology and Statistics Research Centre - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Université de Paris, Paris, FranceObjective(s): Blood cultures (BC), when performed in children seen in the emergency department with community-acquired pneumonia (CAP), are most of the time sterile. We described the diagnostic accuracy of white blood cells (WBC), absolute neutrophils count (ANC), C-reactive protein (CRP), and procalcitonin (PCT) to predict blood culture (BC) result in childhood CAP.Study Design: Secondary analysis of a prospective study carried out in eight pediatric emergency departments (France, 2009–2018), including children (≤15 years) with CAP. Analyses involved univariate comparisons and ROC curves.Results: We included 13,752 children with CAP. BC was positive in 137 (3.6%) of the 3,829 children (mean age 3.7 years) in whom it was performed, mostly with Streptococcus pneumoniae (n = 107). In children with bacteremia, ANC, CRP and PCT levels were higher (median 12,256 vs. 9,251/mm3, 223 vs. 72 mg/L and 8.6 vs. 1.0 ng/mL, respectively; p ≤ 0.002), but WBC levels were not. The area under the ROC curve of PCT (0.73 [95%CI 0.64–0.82]) was significantly higher (p ≤ 0.01) than that of WBC (0.51 [0.43–0.60]) and of ANC (0.55 [0.46–0.64]), but not than that of CRP (0.66 [0.56–0.76]; p = 0.21). CRP and PCT thresholds that provided a sensitivity of at least 90% were 30 mg/L and 0.25 ng/mL, respectively, for a specificity of 25.4 and 23.4%, respectively. CRP and PCT thresholds that provided a specificity of at least 90% were 300 mg/L and 20 ng/mL, respectively, for a sensitivity of 31.3 and 28.9%, respectively.Conclusions: PCT and CRP are the best routinely available predictive biomarkers of bacteremia in childhood CAP.https://www.frontiersin.org/articles/10.3389/fped.2021.684628/fullpneumoniabacteremiabiomarkersprocalcitonin (PCT)pneumococcus (Streptococcus pneumoniae)diagnostic test |
| spellingShingle | Danaé Dudognon Corinne Levy Corinne Levy Corinne Levy Corinne Levy Martin Chalumeau Martin Chalumeau Sandra Biscardi Sandra Biscardi Marie-Aliette Dommergues Marie-Aliette Dommergues François Dubos François Dubos Karine Levieux Karine Levieux Marie Aurel Marie Aurel Philippe Minodier Philippe Minodier Ferielle Zenkhri Ferielle Zenkhri Ellia Mezgueldi Ellia Mezgueldi Irina Craiu Irina Craiu Laurence Morin Laurence Morin Stéphane Béchet Emmanuelle Varon Robert Cohen Robert Cohen Robert Cohen Robert Cohen Robert Cohen Jérémie F. Cohen Jérémie F. Cohen The Pneumonia Study Group François Angoulvant Yves Gillet Christèle Gras-Le Guen Isabelle Hau Laure Hees Elise Launay Mathie Lorrot Fouad Madhi Alain Martinot Naim Ouldali Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009–2018 Frontiers in Pediatrics pneumonia bacteremia biomarkers procalcitonin (PCT) pneumococcus (Streptococcus pneumoniae) diagnostic test |
| title | Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009–2018 |
| title_full | Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009–2018 |
| title_fullStr | Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009–2018 |
| title_full_unstemmed | Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009–2018 |
| title_short | Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009–2018 |
| title_sort | diagnostic accuracy of routinely available biomarkers to predict bacteremia in children with community acquired pneumonia a secondary analysis of the gpip activ pneumonia study in france 2009 2018 |
| topic | pneumonia bacteremia biomarkers procalcitonin (PCT) pneumococcus (Streptococcus pneumoniae) diagnostic test |
| url | https://www.frontiersin.org/articles/10.3389/fped.2021.684628/full |
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