• N Díez-Padrisa, Q Bassat, L Morais, C O'Callaghan-Gordo, S Machevo, T Nhampossa, A B Ibarz-Pavón, L Quintó, P L Alonso, and A Roca.
• Barcelona Centre for International Health Research, Universitat de Barcelona, Spain.
• Trop. Med. Int. Health. 2012 Sep 1; 17 (9): 1100-7.

ObjectivesTo evaluate the benefits of using procalcitonin (PCT) and C-reactive protein (CRP) as pre-screening tools to predict blood culture positivity among Mozambican children with clinical severe pneumonia (CSP).Methods586 children <5 years with CSP and no concurrent malaria fulfilled criteria to be included in the study groups. We determined PCT and CRP for all children with positive bacterial culture (BC+ group, n = 84) and of a random selection of children with negative bacterial culture (BC- group, n = 246).ResultsPCT and CRP levels were higher in the BC+ group than the BC- one (PCT: median 7.73 versus 0.48 ng/ml, P < 0.001; CRP: 177.65 mg/l vs. 26.5 mg/l, P < 0.001). In multivariate analysis, PCT was the only independent predictor of the group. To be used as pre-screening tool, PCT presented higher specificities for predetermined sensitivities (≥85%) than CRP. Pursuing a sensitivity of 95%, PCT could reduce the need for bacterial culture by 49% and overall diagnosis costs by 7-35% [assuming variable costs for PCT measurement (ranging from 10 to 30 USD) and a fixed cost of 72.5 USD per blood culture].ConclusionsAmong hospitalised children with CSP and absence of concurrent malaria, PCT pre-screening could help reduce the number of blood cultures and diagnosis costs by specifically targeting patients more likely to yield positive results.© 2012 Blackwell Publishing Ltd.

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