Procalcitonin Predicts Response to Beta-Lactam Treatment in Hospitalized Children with Community-Acquired Pneumonia 英文参考文献.docVIP

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Procalcitonin Predicts Response to Beta-Lactam Treatment in Hospitalized Children with Community-Acquired Pneumonia 英文参考文献.doc

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Procalcitonin Predicts Response to Beta-Lactam Treatment in Hospitalized Children with Community-Acquired Pneumonia 英文参考文献

ProcalcitoninPredictsResponsetoBeta-Lactam TreatmentinHospitalizedChildrenwithCommunity- AcquiredPneumonia Je′re′mieF.Cohen1,2*,AlexanderLeis2,ThibaultLecarpentier1,JosetteRaymond3,DominiqueGendrel1, MartinChalumeau1,2 1DepartmentofPediatrics,Saint-Vincent-de-PaulandNecker-Enfants-MaladesHospital,AP–HP,Universite′ Paris-Descartes,Paris,France,2EpidemiologicalResearchUnit onPerinatalHealthandWomen’sandChildren’sHealth(U953),Inserm,Paris,France,3DepartmentofMicrobiology,CochinHospital,AP–HP,Universite′ Paris-Descartes, Paris,France Abstract Background:Antibiotictreatmentofcommunity-acquiredpneumonia(CAP)inchildrenremainsmostlyempiricalbecause clinicalandparaclinicalfindingspoorlydiscriminatetheprincipalcausesofCAP.Fastresponsetobeta-lactamtreatmentcan beconsideredaproxyofpneumococcalaetiology.Weaimedtoidentifythebestbiologicalpredictorofresponsetobeta- lactamtherapyinchildrenhospitalizedforCAP. Methods:Aretrospective,single-centrecohortstudyincludedallconsecutivepatients1monthto16yearsoldhospitalized inateachinghospitalinParis,France,becauseofCAPempiricallytreatedwithabeta-lactamalonefrom2003to2010.Uni- and multivariate analyses were used to study the ability of routine biological parameters available in the Emergency Departmenttopredictafavourableresponsetobeta-lactam(definedasapyrexiawithin48hoursoftreatmentonset). Results:Amongthe125includedpatients,85%(106)showedafavourableresponsetobeta-lactam.Inmultivariatelogistic regression,wefoundprocalcitonin(PCT)theonlyindependentpredictorofapyrexia(p=0.008).Theadjustedoddsratiofor the decadic logarithm of PCT was 4.3 (95% CI 1.5–12.7). At $3ng/mL, PCT had 55.7% sensitivity (45.7–65.3), 78.9% specificity(54.4–93.9),93.7%positivepredictivevalue(84.5–98.2),24.2%negativepredictivevalue(14.2–36.7),2.64positive likelihoodratio(1.09–6.42)and0.56negativelikelihoodratio(0.41–0.77).Inthe4childrenwithaPCTlevel$3ng/mLand whoshowednoresponsetobeta-lactamtreatment,secondarypleuraleffusionhaddevelopedin3,andviralco-infecti