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Identifying severe bacterial infection in children with fever without source

Annick Galetto-Lacour1, Alain Gervaix

  • 1Division of Pediatric Emergency Medicine, Geneva University Hospitals and University of Geneva, 1211 Geneva 14, Switzerland. annick.galetto@hcuge.ch

Expert Review of Anti-Infective Therapy
|November 16, 2010
PubMed

Insights

Identifying severe bacterial infections in young children with fever is challenging. A new risk index combining procalcitonin, C-reactive protein, and urinary dipstick shows promise for accurate diagnosis.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Clinical Diagnostics

Background:

  • Differentiating severe bacterial from viral infections in febrile children without a source is a persistent clinical challenge.
  • Current guidelines often suggest white blood cell count, but C-reactive protein and procalcitonin demonstrate superior diagnostic characteristics.
  • Existing clinical decision rules are often too complex for practical implementation.

Purpose of the Study:

  • To evaluate the effectiveness of a novel risk index score in identifying severe bacterial infections in young children.
  • To assess the diagnostic accuracy of combining procalcitonin, C-reactive protein, and urinary dipstick tests.

Main Methods:

  • A review of existing literature on diagnostic markers for fever without source in children.
  • Analysis of a recently proposed simple risk index score incorporating procalcitonin, C-reactive protein, and urinary dipstick results.
  • Assessment of the predictive value of this combined index for severe bacterial infections.

Main Results:

  • No single perfect marker currently exists to reliably differentiate bacterial from viral infections in febrile children.
  • A combined risk index using procalcitonin, C-reactive protein, and urinary dipstick has shown promising predictive value.
  • This simplified approach may offer improved diagnostic accuracy compared to individual markers or complex rules.

Conclusions:

  • The combination of procalcitonin, C-reactive protein, and urinary dipstick in a risk index score presents a potentially valuable tool for diagnosing severe bacterial infections in children.
  • Further impact analyses are required to confirm improved quality of care and clinical utility in real-world settings.

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