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Point-of-care testing for procalcitonin in identifying bacterial infections in young infants: a diagnostic accuracy
Thomas Waterfield1, Julie-Ann Maney2, Martin Hanna2
1Centre for Experimental Medicine, Wellcome Wolfson Institute of Experimental Medicine, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK. twaterfield01@qub.ac.uk.
Insights
Point-of-care procalcitonin testing accurately identifies invasive bacterial infections in infants. This rapid diagnostic tool aids in emergency department assessments for young children with suspected infections.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Diagnostics
- Biomarker Analysis
Background:
- Invasive bacterial infections pose a significant risk to young infants.
- Accurate and rapid diagnosis is crucial for timely treatment and improved outcomes.
- Procalcitonin (PCT) is a biomarker investigated for its role in bacterial infection detection.
Purpose of the Study:
- To evaluate the diagnostic accuracy of point-of-care testing (POCT) for procalcitonin (PCT) in identifying invasive bacterial infections (IBI) in young infants.
- To determine the sensitivity and specificity of POCT-PCT for IBI detection.
Main Methods:
- Prospective observational diagnostic accuracy study.
- Inclusion of infants under 90 days with suspected bacterial infection.
- POCT-PCT performed in the emergency department with results within 20 minutes.
Main Results:
- 126 infants were included; 3.2% had invasive bacterial infections.
- POCT-PCT showed excellent diagnostic accuracy (AUC 0.97).
- At a cutoff of 1.0 ng/ml, sensitivity was 1.00 and specificity was 0.92 for IBI.
Conclusions:
- Point-of-care procalcitonin testing is a rapid and accurate method for identifying invasive bacterial infections in young infants.
- POCT-PCT can be effectively utilized in emergency settings to aid clinical decision-making.
Background:
The primary objective of this study was to report on the diagnostic accuracy of point-of-care testing (POCT) for procalcitonin (PCT) in identifying invasive bacterial infections in young infants. Invasive bacterial infection was defined as the isolation of a bacterial pathogen in blood or cerebrospinal fluid culture.
Methods:
This was a prospective observational diagnostic accuracy study. Young infants less than 90 days of age presenting to the Royal Belfast Hospital for Sick Children with signs of possible bacterial infection were eligible for inclusion. Eligible infants underwent point-of-care testing for procalcitonin in the emergency department. Testing was performed by clinical staff using 0.5 ml of whole blood. Results were available within 20 min.
Results:
126 children were included over a 5-month period between September 2017 and January 2018. There were 14 children diagnosed with bacterial infections (11.1%). Of these 4 children were diagnosed with invasive bacterial infections (3.2%). POCT procalcitonin demonstrated an excellent diagnostic accuracy for identifying children with invasive bacterial infection area under the curve (AUC) of 0.97(95% CI, 0.94 to 1.0). At a cut-off value of 1.0 ng/ml is highly accurate at identifying infants at risk of invasive bacterial infection with a sensitivity and specificity of 1.00 and 0.92 respectively.
Conclusions:
Point-of-care procalcitonin can be performed quickly in the emergency department and demonstrates an excellent diagnostic accuracy for the identification of young infants with invasive bacterial infections.
Trial Registration:
NCT03509727 Retrospectively registered on 26th April 2018.
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