Serum procalcitonin levels in children with clinical syndromes for targeting antibiotic use at an Emergency Department of a Kenyan Hospital

Serum procalcitonin (PCT) was measured in 228 children aged 1 month to 15 years at an emergency department of a hospital located in an area without local malaria transmission in children with suspected infections; 21% (49) children had a clinical syndrome for suspected bacterial infections (Syndrome^+ve). In children with Syndrome^+ve criteria, 27/49 (55.1%) had PCT ≥0.5 μg/l but only 59/179 (32.9%) of those Syndrome^-ve had abnormal PCT, χ² = 8.0, p = 0.005; positive likelihood ratio = 2.0 [95% confidence interval (CI) 1.2-3.3]; negative likelihood ratio = 0.8 (95% CI 0.7-1.0). In patients with pneumonia, 9/15 (60%) with severe pneumonia had PCT ≥0.5 μg/l compared to 11/21 (52.4%) with non-severe pneumonia, χ² = 0.2, p = 0.65. Children with clinical signs of pneumonia or clinical signs suggestive of bacterial infections fulfilling clinical syndromic definitions for suspected bacterial infections commonly have elevated PCT level. PCT levels are associated with disease severity and antibiotic trials guided by PCT levels may be needed where cultures are not available.