Evaluation of blood culture and serum procalcitonin for diagnosis of septicaemia in paediatric patients
Journal Title: Indian Journal of Microbiology Research - Year 2016, Vol 3, Issue 3
Abstract
Background: Septicaemia is a major cause of mortality and morbidity in paediatric age group in our country. The present study was aimed to evaluate the usefulness of procalcitonin assay in critically ill children with suspected sepsis taking blood culture as gold standard of diagnosis. The initial presentation of septicaemia may be subtle and therefore, it is important not only to recognise the children with septicaemia but also to manage the patients early with proper antibiotics. Materials and Methods: 192 patients from NICU (Neonatal Intensive Care Unit) and PICU (Paediatric Intensive Care Unit) with suspected sepsis were enrolled in the study. Blood culture and estimation of serum procalcitonin were done in all the patients. Different risk factors associated with septicaemia in paediatric and neonatal age group were also analysed using three different cut-off values for PCT (≥0.5 ng/ml, ≥ 2 ng/ml and ≥10 ng/ml). Sensitivity, specificity, PPV (Positive predictive value), NPV (Negative Predictive value) were determined for PCT ≥0.5 ng/ml, ≥ 2 ng/ml and ≥10 ng/ml considering blood culture as gold standard diagnosis of septicaemia. Bacteriological profile and antibiogram of septicaemia were also determined in our study. Results: Out of 192 suspected cases, 90(47%) patient were blood culture positive. Out of 90 proven cases of septicaemia, 51(57%) cases were neonates. In our study sensitivity, specificity, PPV (Positive predictive value), NPV (Negative Predictive value) for ≥ 2ng/ml were 70%, 81%, 77%, 75% respectively. For cut off ≥10 ng/ml specificity increased to 91% and sensitivity decreased to 40%. Gram negative septicaemia was encountered in 69% of culture positive cases and the most common isolate was found to be Escherichia coli. Conclusion: It is challenging to distinguish sepsis from non-infectious condition in critically ill children. Serum procalcitonin assay is one of the important biomarkers of sepsis. In our study we observed moderate sensitivity and specificity for procalcitonin as a marker for sepsis. Procalcitonin can help in avoiding unwarranted antibiotic usage. Blood culture with antimicrobiobial susceptibility testing still remains the gold standard diagnosis of septicaemia.
Authors and Affiliations
Dipmala Das, Nitin Barua, JN Sharma
Keywords
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