XXXX to Detect Suspected Bacterial Infections in the PICU.

@entity1 @entity281 @entity1904 @entity2348
OBJECTIVES: Nonspecific clinical symptoms frequently lead to suspicion of @entity2348 in critically ill @entity1 . Clinicians send bacterial cultures for suspected @entity281 and begin an empiric course of antibiotics while microbiology results are pending. We investigated whether the biomarker @entity1904 could be useful to predict confirmed @entity2348 in critically ill @entity1 in the PICU, before culture results are available. DESIGN: Prospective, blinded single-center study. SETTING: Tertiary PICU and cardiothoracic ICU. @entity1 : There were one hundred forty-four @entity1 with suspected @entity2348 that had bacterial cultures sent by clinicians. INTERVENTIONS: @entity1904 samples were obtained at three time intervals: as close to the time of the initial culture as possible (up to 12 hr after) and 24 and 72 hours after the initial culture. @entity1 were stratified into clinical outcome groups based on microbiology results and clinical symptoms using Centers for Disease Control and Prevention criteria. These assignments were blinded to @entity1904 levels. Primary outcome was the presence of culture-proven @entity2348 . MEASUREMENTS AND MAIN RESULTS: There was a statistically significant difference in initial and subsequent median @entity1904 values between @entity1 with confirmed @entity2348 and @entity1 with low suspicion of @entity2348 (p < 0.02). However, there was extremely high variability in @entity1904 values among all groups. @entity1904 had only a fair ability to predict @entity2348 , with area under the curve of receiver operating characteristic plots ranging between 0.63 and 0.71. When using serial @entity1904 values to predict @entity2348 were near 1 and negative likelihood ratios were between 0.3 and 0.4. CONCLUSIONS: @entity1904 levels were higher in @entity1 with documented confirmed @entity2348 as compared with those with low suspicion of @entity281 . However, neither single nor serial @entity1904 measurements were able to predict the presence or absence of confirmed @entity2348 with enough certainty to be clinically useful as to recommend initiating or withholding antibiotics.
