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The current standard in diagnosing and treating pediatric infections is obtaining cultures, interpreting complete blood count results, and following the trends of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Infection triggers an inflammatory response; if untreated or mistreated, this microbe invasion can lead to sepsis. The purpose of this submission is to address the promising use of procalcitonin levels (PCT) as a superior marker in the early detection of bacterial infection via a scholarly literature review. 

Studies involving PCT are more readily found in the evaluation of the neonatal population and in adults with respiratory illnesses. Pediatric studies are limited, therefore more research and an increased number of subjects are needed to validate PCT as being the best marker for early bacterial detection. PCT levels in a healthy individual are almost undetectable and will rise sharply when the inflammatory response is triggered by invading bacteria. PCT levels normalize faster than CRP levels in response to appropriate therapy; antibiotic therapy can be individualized to match this recovery. ESR and CRP do not differentiate bacterial infections from other invaders thus a predetermined antibiotic course is indiscriminately prescribed. The literature explains that PCT levels could encourage prompt diagnosis, early treatment and antibiotic stewardship. 

A scholarly search of more than 30 journal articles was reviewed and critiqued by the presenters. Research shows that in adults and neonates, PCT is the standard for diagnosing and treating bacterial infections. Elevated PCT levels in neonates determine the need for antibiotic treatment in bacterial infection or supportive treatment in its absence (viral infection). Determining the nature of increased inflammation is crucial to treatment; it can help isolate infections in adults presenting with pre-existing respiratory diseases, like COPD. Studies on the pediatric population show promise that PCT will be just as crucial in bacterial infections.

Levy, H., & Sayegh, M. (2019). Procalcitonin testing as an aid to antibiotic stewardship. Medical Laboratory Observer, 51(9). https://www.mlo-online.com/disease/antibiotic-resistance/article/21093254/procalcitonin-testing-as-an-aid-to-antibiotic-stewardship

Memar, M. Y., Varshochi, M., Shokouhi, B., Asgharzadeh, M., & Kafil, H. S. (2017). Procalcitonin: The marker of pediatric bacterial infection. Biomedicine & Pharmacotherapy, 96, 936-943. DOI:10.1016/j.biopha.2017.11.149

Poddar, B., Gurjar, M., Singh, S., Aggarwal, A., & Baronia, A. (2016). Reduction in procalcitonin level and outcome in critically ill children with severe sepsis/septic shock--A pilot study. Journal of Critical Care, 36, 230-233. DOI: 10.1016/j.jcrc.2016.07.022

Trippella, G., Galli, L., Martino, M. D., Lisi, C., & Chiappini, E. (2017). Procalcitonin performance in detecting serious and invasive bacterial infections in children with fever without apparent source: A systematic review and meta- analysis. Expert Review of Anti-infective Therapy, 15(11), 1041-1057. DOI:10.1080/14787210.2017.1400907

Vijayan, A. L., Vanimaya, Ravindran, S., Saikant, R., Lakshmi, S., Kartik, R., & G, M. (2017). Procalcitonin: A promising diagnostic marker for sepsis and antibiotic therapy. Journal of Intensive Care, 5(1). DOI:10.1186/s40560-017-0246- 8

Publication Date

2021

Disciplines

Pediatric Nursing

Squashing Superbugs: Using Procalcitonin Levels toIdentify Bacterial Infections to Direct Antibiotic Therapy

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