Procalcitonin, IL-6, IL-8, IL-1 receptor antagonist and C-reactive proteinas identificators of serious bacterial infections in children with fever without localising signs

Fever without localising signs in very young children remains a diagnostic problem. Until present, a clinical scoring system combined with leucocyte c ount, urine analysis and determination of CRP are recognised as being helpf ul to identify patients at risk of serious bacterial illness. In this study we asked the question whether the determination of procalcitonin (PCT), in terleukin (IL)-6. IL-8 and interleukin-1 receptor antagonist (IL-1Ra) was s uperior to these commonly used markers for the prediction of a serious bact erial infection (SBI). Children, 7 days to 36 months of age, with a rectal temperature above 38 degreesC and without localising signs of infection wer e prospectively enrolled. For each infant. we performed a physical examinat ion, a clinical score according to McCarthy, a complete white cell count, a n urine analysis and a determination of CRP. We further determined PCT, IL- 6, IL-8, and IL-1Ra concentrations and compared their predictive value with those of the usual management of fever without localising signs. Each infa nt at risk of SBI had blood culture, urine and cerebrospinal fluid cultures when indicated, and received antibiotics until culture results were availa ble. A total of 124 children were included of whom 28 (23%) had SBI. Concen trations of PCT, CRP and IL6 were significantly higher in the group of chil dren with SBI but IL-8 and IL-1Ra were comparable between both groups. PCT showed a sensitivity of 93% and a specificity of 78% for detection of SBI a nd CRP had a sensitivity of 89% and a specificity of 75%. Conclusion Compared to commonly used screening methods such as the McCarthy score, leucocyte count and other inflammatory markers such as interleukin- 6, interleukin-8 and interleukin-1 receptor antagonist, procalcitonin and C -reactive protein offer a better sensitivity and specificity in predicting serious bacterial infection in children with fever without localising signs .