• Annick Galetto-Lacour, Gabriel Alcoba, Klara M Posfay-Barbe, Manon Cevey-Macherel, Mario Gehri, Martina M Ochs, Roger H Brookes, Claire-Anne Siegrist, and Alain Gervaix.
• From the *Division of Pediatric Emergency Medicine; †Department of Child and Adolescent Medicine, Geneva University Hospitals and University of Geneva, Geneva; ‡Child and Adolescent Department, University Hospital, Lausanne, Switzerland; §Sanofi Pasteur, Marcy l'Etoile, France; and ¶Sanofi Pasteur, Toronto, Canada.
• Pediatr. Infect. Dis. J. 2013 Nov 1; 32 (11): 1175-9.

BackgroundOur objective was to evaluate procalcitonin (PCT) and C-reactive protein (CRP) as predictors of a pneumococcal etiology in community-acquired pneumonia (CAP) in hospitalized children.MethodsChildren requiring hospitalization for CAP were prospectively enrolled. The following indices were determined: antibodies against pneumococcal surface proteins (anti-PLY, pneumococcal histidine triad D, pneumococcal histidine triad E, LytB and pneumococcal choline-binding protein A), viral serology, nasopharyngeal cultures and polymerase chain reaction for 13 respiratory viruses, blood pneumococcal polymerase chain reaction, pneumococcal urinary antigen, PCT and CRP. Presumed pneumococcal CAP (P-CAP) was defined as a positive blood culture or polymerase chain reaction for Streptococcus pneumoniae or as a pneumococcal surface protein seroresponse (≥2-fold increase).ResultsSeventy-five patients were included from which 37 (49%) met the criteria of P-CAP. Elevated PCT and CRP values were strongly associated with P-CAP with odds ratios of 23 (95% confidence interval: 5-117) for PCT and 19 (95% confidence interval: 5-75) for CRP in multivariate analysis. The sensitivity was 94.4% for PCT (cutoff: 1.5 ng/mL) and 91.9% for CRP (cutoff: 100 mg/L). A value≤0.5 ng/mL of PCT ruled out P-CAP in >90% of cases (negative likelihood ratio: 0.08). Conversely, a PCT value≥1.5 ng/mL associated with a positive pneumococcal urinary antigen had a diagnostic probability for P-CAP of almost 80% (positive likelihood ratio: 4.59).ConclusionsPCT and CRP are reliable predictors of P-CAP. Low cutoff values of PCT allow identification of children at low risk of P-CAP. The association of elevated PCT or CRP with a positive pneumococcal urinary antigen is a strong predictor of P-CAP.

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