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Procalcitonin in detecting neonatal nosocomial sepsis
  1. Cinzia Auriti1,
  2. Ersilia Fiscarelli2,
  3. Maria Paola Ronchetti1,
  4. Marta Argentieri2,
  5. Gabriella Marrocco1,
  6. Anna Quondamcarlo1,
  7. Giulio Seganti1,
  8. Francesco Bagnoli3,
  9. Giuseppe Buonocore3,
  10. Giovanni Serra4,
  11. Gianfranco Bacolla5,
  12. Savino Mastropasqua6,
  13. Annibale Mari7,
  14. Carlo Corchia1,
  15. Giusi Prencipe1,
  16. Fiammetta Piersigilli1,
  17. Lucilla Ravà8,
  18. Vincenzo Di Ciommo8
  1. 1Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Rome, Italy
  2. 2Laboratory Department, Bambino Gesù Children's Hospital, Rome, Italy
  3. 3Neonatal Intensive Care Unit, Le Scotte University Hospital, Siena, Italy
  4. 4Neonatal Intensive Care Unit, Giannina Gaslini Pediatric Hospital, Genoa, Italy
  5. 5Neonatal Intensive Care Unit, Burlo Garofolo Research Institute, Trieste, Italy
  6. 6Neonatal Intensive Care Unit, Di Venere Hospital, Bari, Italy
  7. 7Neonatal Intensive Care Unit, General Hospital, Cosenza, Italy
  8. 8Epidemiology Unit, Bambino Gesù Children's Hospital, Rome, Italy
  1. Correspondence to Dr Cinzia Auriti, Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital, Piazza S Onofrio, 4-00165 Rome, Italy; c.auriti{at}agtgroup.it

Abstract

Objective To investigate the accuracy of procalcitonin (PCT) as a diagnostic marker of nosocomial sepsis (NS) and define the most accurate cut-off to distinguish infected from uninfected neonates.

Setting Six neonatal intensive care units (NICUs).

Patients 762 neonates admitted to six NICUs during a 28-month observational study for whom at least one serum sample was taken on admission.

Main outcome measures Positive and negative predictive values at different PCT cut-off levels.

Results The overall probability of an NS was doubled or more if PCT was >0.5 ng/ml. In very-low-birth-weight (VLBW) infants, a cut-off of >2.4 ng/ml gave a positive predictive value of NS near to 50% with a probability of a false-positive diagnosis of NS in about 10% of the patients.

Conclusions In VLBW neonates, a serum PCT value >2.4 ng/ml prompts early empirical antibiotic therapy, while in normal-birth-weight infants, a PCT value ≤2.4 ng/ml carries a low risk of missing an NS.

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Footnotes

  • Funding The study was funded by the Italian Ministry of Health research grant number 99010661.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the institutional ethical board at each centre approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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