Role of procalcitonin in diagnosis of neonatal sepsis and procalcitonin guided duration of antibiotic therapy

Authors

  • Abnish Kumar Bharti Department of Pediatrics, Hindu Rao Hospital and North DMC Medical College, Delhi, India
  • Manoj Kumar Verma Department of Pediatrics, Maulana Azad Medical College, Delhi, India
  • Anuj Gupta Department of Pediatrics, Hindu Rao Hospital and North DMC Medical College, Delhi, India
  • Devendra Kumar Mishra Department of Pediatrics, Hindu Rao Hospital and North DMC Medical College, Delhi, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20203088

Keywords:

C-reactive protein, Neonatal sepsis, Procalcitonin

Abstract

Background: Neonatal sepsis is one of the important causes of neonatal morbidity and mortality particularly in the developing countries. Accurate and quick diagnosis is difficult because clinical presentation is non-specific, bacterial cultures are time-consuming and other laboratory tests lack sensitivity and specificity. Procalcitonin (PCT) is often reported to be more superior to C-reactive protein (CRP), being more sensitive and specific, starts to rise earlier and returns to normal concentration more rapidly than CRP.

Methods: It is a hospital based prospective observational study. Blood samples were obtained and analyzed for blood culture, septic screen including serum CRP and PCT. Neonates were categorized into proven sepsis (n=39), probable sepsis (n=21) and clinical sepsis (n=40) groups on the basis of laboratory findings and risk factors. Data was analyzed by using standard statistical tests using SPSS 16.

Results: Out of 100 cases, elevated PCT level >0.5 ng/dl was detected in 75 and >2 ng/dl was detected in 51 whereas CRP was positive only in 61 cases. Among the 39 culture positive cases, elevated serum PCT level was noticed in 39 (100%) cases whereas CRP level was noticed in 30 (76.9%) cases. Mean PCT levels were significantly high according to infection severity (P<0.01). Procalcitonin (sensitivity 87.2%, specificity 72.13%, positive predictive value 66.7% and negative predictive value 89.8% and with p value of <0.001) is more superior than CRP to predict sepsis in neonate. The mean duration of antibiotic therapy was 12.46±4.62 days in definite sepsis, 4.53±1.78 days in probable sepsis group and in clinical sepsis group 3.75±1.33 days by serial PCT measurement.

Conclusions: Serum PCT levels >2 ng/dl has got a better sensitivity and NPV, which help us not only in the early diagnosis but also in the prognosis and duration of antibiotic therapy.

Author Biographies

Abnish Kumar Bharti, Department of Pediatrics, Hindu Rao Hospital and North DMC Medical College, Delhi, India


Manoj Kumar Verma, Department of Pediatrics, Maulana Azad Medical College, Delhi, India


Anuj Gupta, Department of Pediatrics, Hindu Rao Hospital and North DMC Medical College, Delhi, India


Devendra Kumar Mishra, Department of Pediatrics, Hindu Rao Hospital and North DMC Medical College, Delhi, India


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Published

2020-07-22

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Original Research Articles