DIAGNOSTIC UTILITY OF PROCALCITONIN IN CHILDREN WITH SEPSIS IN LAGOS UNIVERSITY TEACHING HOSPITAL

Abstract

Background: Sepsis is a life threatening disease which is associated with high morbidity
and mortality. The early diagnosis and the appropriate treatment of sepsis is a daily
challenge in medical practice
Objective: To evaluate the utility of semi-quantitative procalcitonin determination in
identifying paediatric patients with sepsis in children in Lagos University Teaching
Hospital.
Setting: The Lagos University Teaching Hospital (LUTH) is a 761 bed tertiary healthcare
center with four neonatal wards.
Methods: A total of 388 in-patients in the Pediatric wards that had signs and symptoms
suggestive of sepsis were consecutively recruited into the study. Blood was collected
aseptically for Procalcitonin and blood culture using the BACTEC PedF aerobic (BD
Diagnostics) bottles. The blood culture bottles were incubated for up to 5 days. Isolates were
identified and susceptibility testing performed on them using the modified Kirby-Bauer
method. Resistance testing was done for extended spectrum beta lactamase (ESBL) and
methicillin resistant Staphylococcus aureus (MRSA) expression using Clinical Laboratory
Standards Institute (CLSI) guidelines. Plasma sample was used for procalcitonin assay.
Results: One hundred and thirty two patients had positive blood culture (bacteremic group)
with high PCT levels. Two hundred and fifty six patients had negative blood culture.
Procalcitonin levels were higher among the patients with gram negative bacteremia than
gram positive bacteremia.
Klebsiella pneumoniae was the predominant pathogen among the Gram negative isolates
while Staphylococcus aureus was the predominant among the Gram positive. Over sixty
percent of Gram negative isolates were ESBL producers. None of the ESBL isolates was
Modified Hodge Test positive.
Conclusion: The significance of PCT has been proven in available literature and this study,
as a useful means on reducing diagnostic turnaround time for septic patients, averse
injudicious and inappropriate use of antibiotics, appropriate use of empirical therapy where
needed, reduced hospital costs of antibiotics and possible antibiotic resistance.