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Comment & Response |

Use of Procalcitonin Assays to Predict Serious Bacterial Infection in Young Febrile Infants

James W. Antoon, MD, PhD1; Michael J. Steiner, MD, MPH2
[+] Author Affiliations
1Department of Pediatrics and Adolescent Medicine, Children's Hospital, University of Illinois Hospital and Health Sciences System, Chicago
2Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, North Carolina Children’s Hospital, University of North Carolina School of Medicine, Chapel Hill
JAMA Pediatr. 2016;170(6):623. doi:10.1001/jamapediatrics.2016.0382.
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To the Editor We commend Milcent et al1 on their prospective study on the use of procalcitonin in the diagnosis of serious bacterial infections in infants. We believe there are 3 issues that limit applicability of the study as presented.

First, the Milcent et al study1 included patients classified with the clinical appearance determined as “minimally, moderately, or very ill.” There is general agreement to perform a full workup on all febrile infants who do not appear well. Additionally, for those ill-appearing infants who undergo full evaluation, urinalyses and cerebrospinal fluid studies have high sensitivity for urinary tract infection and meningitis, respectively, in febrile infants. The management of well-appearing febrile infants is more controversial, with generally good outcomes demonstrated even with highly variable evaluation strategies.2,3 Therefore, the crucial clinical struggle is to more quickly and accurately detect systemic bacterial infections, and particularly bacteremia, in well-appearing febrile infants. In terms of clinical decision making, the study could provide crucial information by providing the test characteristics for procalcitonin in well-appearing infants or those with low Yale Observation Scale scores. We did note that in this study, the Yale Observation Scale was not helpful in detecting serious or invasive bacterial infection. Again, exploring Yale Observation Scale scores and the general impression of illness when applying the results could be helpful.

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Correspondence

January 1, 2016
Karen Milcent, MD, MSc; Sabine Faesch, MD; Christèle Gras-Le Guen, MD, PhD; François Dubos, MD, PhD; Claire Poulalhon, MD; Isabelle Badier, MD; Elisabeth Marc, MD; Christine Laguille, MD; Loïc de Pontual, MD, PhD; Alexis Mosca, MD; Gisèle Nissack, MD; Sandra Biscardi, MD; Hélène Le Hors, MD, PhD; Ferielle Louillet, MD; Andreea Madalina Dumitrescu, MD; Philippe Babe, MD; Christelle Vauloup-Fellous, PharmD, PhD; Jean Bouyer, PhD; Vincent Gajdos, MD, PhD
1Department of Pediatrics, Antoine Béclère University Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France2INSERM, CESP Centre for Research in Epidemiology and Population Health, Paris-Sud, Paris-Saclay University, Villejuif, France
3Pediatric Emergency Department, Paris Descartes University, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
4Department of Pediatrics, Hôpital Mère Enfant, Nantes University Hospital, Nantes, France
5Pediatric Emergency Unit and Infectious Diseases, Lille University, Lille, France
2INSERM, CESP Centre for Research in Epidemiology and Population Health, Paris-Sud, Paris-Saclay University, Villejuif, France
6Department of Pediatrics, Poissy Hospital, Poissy, France
7Department of Pediatrics, Kremlin Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
8Department of Pediatrics, Dupuytren University Hospital, Limoges, France
9Department of Pediatrics, Jean Verdier Hospital, Assistance Publique-Hôpitaux de Paris, Paris 13 University, Bondy, France
10Department of Pediatrics, Sud Francilien Hospital, Corbeil-Essonnes, France
11Department of Pediatrics, Centre Hospitalier de Marne La Vallée, Jossigny, France
12Department of Pediatrics, Créteil Hospital, Créteil, France
13Department of Paediatric Surgery, Hôpital d'Enfants de La Timone, Marseille, France
14Department of Pediatrics, Rouen University Hospital, Rouen, France
15Department of Pediatrics, Louis Mourier University Hospital, Assistance Publique-Hôpitaux de Paris, Colombes, France
16Pediatric Emergency Unit, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
17Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Virologie, National Reference Laboratory for Maternofetal Rubella Infections, Villejuif, France
JAMA Pediatr. 2016;170(1):62-69. doi:10.1001/jamapediatrics.2015.3210.
June 1, 2016
Philip N. Britton, MBBS, FRACP
1Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney
JAMA Pediatr. 2016;170(6):622-623. doi:10.1001/jamapediatrics.2016.0379.
June 1, 2016
Karen Milcent, MD, PhD; Vincent Gajdos, MD, PhD
1Department of Pediatrics, Antoine Béclère University Hospital, Assistance Publique-Hôpitaux de Paris, Clamart, France2Université Paris-Sud, INSERM, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France
JAMA Pediatr. 2016;170(6):623-624. doi:10.1001/jamapediatrics.2016.0385.
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