降钙素原对儿童细菌性脑膜炎鉴别诊断的meta分析

目的 探讨降钙素原(PCT)对儿童细菌性脑膜炎的诊断价值。方法 采用计算机检索获得PCT对儿童细菌性脑膜炎的诊断性研究文献，检索时间为建库至2013年7月，按照QUADAS 标准评价纳入文献质量。采用Meta-Disc 1.4 软件进行Meta分析，对敏感度、特异度、阳性似然比、阴性似然比进行汇总和异质性检验，绘制综合受试者特征曲线（SROC），行敏感性分析和异质性原因分析。使用Stata 12.0软件判断发表偏移并绘制漏斗图。结果 12篇文献进入Meta分析（中文5篇，英文7篇）。①汇总敏感度0.95（95%CI:0.92~0.97），特异度0.89（95%CI:0.86~0.92），阳性似然比11.09（95%CI:5.73~21.49）,阴性似然比0.07（95%CI:0.05~0.11），诊断比值比122.01（95%CI:65.08~228.75），SROC 曲线下面积（AUC）0.977 7，Q*指数0.933。②分别剔除样本量<50文献、中文文献和回顾性研究文献的敏感性分析显示，上述诊断参数的95％CI与原数据有较大重叠。③特异度、阳性似然比的文献间存在显著的异质性，研究地域、PCT检测方法和细菌性脑膜炎诊断标准可能不是异质性产生的原因。④以PCT 5 μg·L-1界值诊断儿童细菌性脑膜炎的敏感度、特异度，SROC AUC和Q*指数最大。结论 PCT在鉴别诊断儿童细菌性脑膜炎与病毒性脑膜炎中有较高的敏感度和特异度，但各研究间存在异质性，使用PCT鉴别诊断儿童细菌性脑膜炎仍需结合具体的临床情况。     

γ干扰素释放试验诊断儿童潜伏结核菌感染的Meta分析

目的以结核菌素皮肤试验(TST)为参考试验,评价QuantiFERON-TB Gold test(QFT)和T-SPOT.TB两种IFN-γ释放试验诊断儿童潜伏结核菌感染的准确性。方法计算机检索EMBASE、PubMed、Cochrane图书馆、中文科技期刊全文数据库、中国期刊全文数据库和万方数字化期刊群等数据库,检索时间均为建库至2010年3月。全面检索IFN-γ释放试验诊断儿童潜伏结核菌感染的文献,按照诊断试验的纳入标准筛选文献,提取纳入文献的特征信息(研究背景、设计信息和诊断参数信息)。根据QUADAS质量评价标准评价纳入文献的质量。采用Meta-Disc1.4软件进行Meta分析,检验异质性,并根据异质性结果选择相应的效应模型。对纳入文献予以加权定量合并,计算汇总敏感度、特异度、阳性似然比、阴性似然比和诊断优势比及其95%CI,绘制汇总受试者工作特征(SROC)曲线,并计算曲线下面积(AUC)。结果共检出相关文献285篇,按照文献纳入标准,最终纳入13篇文献(英文文献12篇和中文文献1篇)。10篇文献报道了QFT试验对儿童潜伏结核菌感染的诊断价值,汇总敏感度为0.40(95%CI:0.37~0.44)、汇总特异度为0.87(95%CI:0.85~0.88)、汇总阳性似然比为6.21(95%CI:3.07~12.54)、汇总阴性似然比为0.46(95%CI:0.31~0.68)、汇总诊断优势比为15.58(95%CI:7.47~32.48),SROC AUC为0.8931。4篇文献报道了T-SPOT.TB试验对儿童潜伏结核菌感染的诊断价值,汇总敏感度为0.74(95%CI:0.68~0.79)、汇总特异度为0.84(95%CI:0.81~0.87)、汇总阳性似然比为4.66(95%CI:1.27~17.12)、汇总阴性似然比为0.42(95%CI:0.18~0.99)、汇总诊断优势比为13.71(95%CI:3.71~50.72),SROCAUC为0.8306。结论 IFN-γ释放试验适用于进一步鉴别诊断儿童是否处于潜伏结核菌感染,不适合儿童潜伏结核菌感染的筛查。     

实时荧光定量聚合酶链反应检测妊娠晚期孕妇和新生儿B族溶血性链球菌价值的系统评价和Meta分析

目的评价实时荧光定量PCR(RT-PCR)检测妊娠晚期孕妇和新生儿B族溶血性链球菌(GBS)的价值,为GBS感染早期诊断提供依据。方法检索Pub Med、Cochrane图书馆、中国生物医学文献数据库、维普数据库、万方数据库和中国知网,收集RT-PCR用于妊娠晚期孕妇及生后7 d内新生儿GBS并与细菌培养金标准比较的诊断性研究,检索时间均从建库至2015年5月。行文献质量评价,提取诊断参数,采用Meta Disc1.4软件进行Meta分析,计算汇总敏感度、特异度、阳性似然比和阴性似然比,绘制汇总受试者工作特征(SROC)曲线,计算曲线下面积(AUC),评估RT-PCR检测GBS的诊断价值。结果 17篇文献(20项研究)进入Meta分析,其中英文15篇,中文2篇,共纳入研究对象5 660例,5 938个研究标本。1Meta分析结果显示,RT-PCR检测GBS的汇总敏感度为0.92(95%CI:0.90~0.94),特异度为0.94(95%CI:0.93~0.95),阳性似然比为13.81(95%CI:8.80~21.69),阴性似然比为0.11(95%CI:0.06~0.20),SROC AUC为0.972 1,Q*指数为0.923 3。2分别剔除样本量100、中文语种、样本采集时间不明确和靶基因不明的文献行敏感性分析,显示剔除文献后各诊断参数95%CI与原数据基本重叠。3各诊断参数的文献间存在显著的统计学异质性,亚组分析提示研究对象和靶基因可解释部分异质性来源,样本类型可能不是异质性的来源。结论现有证据显示,RT-PCR检测GBS价值较高,可作为妊娠晚期孕妇和新生儿诊断GBS感染的重要检测手段之一。     

肺脏超声对新生儿肺炎诊断价值的Meta分析

目的　采用 Meta 分析方法来评价肺脏超声对新生儿肺炎的诊断价值。方法　检索PubMed、Cochrane library、Embase、CNKI 和万方数据库，按照诊断性试验的纳入和排除标准，获取符合本研究要求的文献，检索时间为建库至 2018年9月。共检索到907篇文献，选取其中8篇进一步分析，并对文献质量进行QUADAS2标准评价，采用Q检验和I 2统计量进行异质性检验，采用 Meta-Disc 1.4 软件进行统计学分析，评价肺脏超声对新生儿肺炎的诊断价值。 结果　共纳入8篇文献、1078例。采用随机效应模型对纳入的研究进行统计分析，合并敏感度为0.96（95%CI：0.95～0.98），合并特异度为0.98（95%CI：0.95～0.99），合并阳性似然比为19.52（95%CI：5.00～76.15），合并阴性似然比为0.04（95%CI：0.01～0.16），合并诊断优势比为565.45（81.80～3908.58），拟合ROC 曲线下面积0.9950。结论　肺脏超声诊断新生儿肺炎的敏感度和特异度较X线高。鉴于其相对容易操作、实时可用、低成本和无电离辐射，目前的证据支持超声作为新生儿肺炎诊断的替代手段。     

C反应蛋白诊断新生儿败血症准确性的Meta分析

目的 探讨CRP诊断新生儿败血症的诊断价值。方法 计算机检索维普中文科技期刊数据库、中国期刊全文数据库、万方数据库、中国生物医学文献数据库、Medline、 EMBASE、Cochrane图书馆、PubMed等数据库（检索时间为1989年1月至2011年7月）,获得CRP诊断新生儿确诊败血症的文献。采用QUADAS工具对纳入文献进行质量评价。采用MetaDisc 1.4和RevMan 5.0软件检验各文献间的异质性,并根据异质性结果选择相应的效应模型进行加权定量合并,计算敏感度和特异度及其95%CI。绘制受试者工作特征（SROC）曲线并计算曲线下面积（AUC）,并行敏感度分析。结果 20篇文献进入Meta分析。分析结果显示：CRP诊断新生儿败血症的汇总敏感度和特异度分别为0.69（95%CI：0.65~0.72）和0.87（95%CI：0.86~0.89）,SROC AUC为0.88,Q*指数为0.81。CRP＞8 mg·L-1诊断新生儿败血症的汇总敏感度和特异度分别为0.88（95%CI：0.82~0.92）和0.86 （95%CI：0.81~0.90）,SROC AUC为0.94,Q*指数为0.88;CRP≥8 mg·L-1诊断新生儿败血症的汇总敏感度和特异度分别为0.54（95%CI：0.47~0.61）和0.81（95%CI：0.76~0.85）,SROC AUC为0.80,Q*指数为0.74;两者合并诊断新生儿败血症的汇总敏感度和特异度分别为0.70（95%CI：0.65～0.74）和0.83（95%CI：0.80～0.86）,SROC AUC为0.88,Q*指数为0.82。在纳入文献中标本来源和检测方法的差异等非阈值效应因素是产生异质性的原因。结论 CRP对新生儿败血症诊断的敏感度和特异度较高,有助于早期诊断新生儿败血症。     

肺脏超声对新生儿肺炎诊断价值的Meta分析

目的　采用 Meta 分析方法来评价肺脏超声对新生儿肺炎的诊断价值。方法　检索PubMed、Cochrane library、Embase、CNKI 和万方数据库,按照诊断性试验的纳入和排除标准,获取符合本研究要求的文献,检索时间为建库至 2018年9月。共检索到907篇文献,选取其中8篇进一步分析,并对文献质量进行QUADAS2标准评价,采用Q检验和I 2统计量进行异质性检验,采用 Meta-Disc 1.4 软件进行统计学分析,评价肺脏超声对新生儿肺炎的诊断价值。 结果　共纳入8篇文献、1078例。采用随机效应模型对纳入的研究进行统计分析,合并敏感度为0.96（95%CI：0.95～0.98）,合并特异度为0.98（95%CI：0.95～0.99）,合并阳性似然比为19.52（95%CI：5.00～76.15）,合并阴性似然比为0.04（95%CI：0.01～0.16）,合并诊断优势比为565.45（81.80～3908.58）,拟合ROC 曲线下面积0.9950。结论　肺脏超声诊断新生儿肺炎的敏感度和特异度较X线高。鉴于其相对容易操作、实时可用、低成本和无电离辐射,目前的证据支持超声作为新生儿肺炎诊断的替代手段。     

粪便钙卫蛋白对新生儿坏死性小肠结肠炎诊断作用的Meta分析

目的 通过Meta分析的方法探讨粪便钙卫蛋白（FC）对新生儿坏死性小肠结肠炎（NEC）的诊断作用。方法 检索Web of Science、Cochrane Library，PubMed、Embase、中国知网（CNKI）、维普期刊数据库、万方数据库、中国生物医学文献数据库，并结合手动检索作为补充，搜索时间为建库至2020年5月。采用QUADAS标准评估纳入文献的质量；采用Meta-Disc 1.4和Stata 15.0软件行Meta分析，包括评价特异度、敏感度、似然比和诊断比值比，进行敏感性分析及异质性测试，绘制综合受试者工作特征（SROC）曲线及Fagan图。结果 共纳入15篇文献，包括1 719例新生儿。其中，低质量文献4篇，高质量文献2篇，其余均为中等质量。纳入研究间异质性较高，不存在阈值效应及发表偏倚。应用随机效应模型分析结果显示：FC对NEC诊断的汇总特异度、灵敏度分别为0.80（95% CI：0.78~0.82）、0.86（95% CI：0.83~0.89），阴性似然比、阳性似然比、诊断比值比分别为0.19（95% CI：0.14~0.26）、4.71（95% CI：3.57~6.23）、29.56（95% CI：17.98~48.61）。SROC曲线下面积为0.9131，Q^*指数为0.8456。Fagan图显示FC不增高时NEC发生概率为13%，FC增高时NEC发生概率提高为86%。Meta回归分析发现异质性来源于其他非协变量因素。结论 FC对NEC的早期诊断具有较高的潜力及效能。FC测定可用于NEC的诊断，但应与临床表现及其他相关实验室检查相结合。     

降钙素原对不同热程不明原因发热儿童严重细菌感染诊断价值的Meta分析

目的 探讨降钙素原（PCT）对不同热程不明原因发热儿童严重细菌感染(SBIs)的诊断价值。方法 计算机检索获得PCT对不明原因发热儿童SBIs诊断价值的文献,检索时间为建库至2014年7月,按照QUADAS标准对纳入文献进行质量评估。使用MetaDisc 1.4软件进行Meta分析,对不同平均热程（<24、～48和>48 h）PCT、WBC和中性粒细胞绝对计数（ANC）诊断SBIs的敏感度、特异度等指标进行汇总,并进行异质性检验,绘制综合受试者工作特征曲线（SROC）,计算曲线下面积（AUC）。使用Stata 12.0软件判断发表偏倚并绘制漏斗图。结果 初检到442篇文献,11篇文献符合纳入标准进入Meta分析（中文1篇,英文10篇）。①平均热程<24 h对SBIs的诊断价值：PCT的汇总敏感度和特异度分别为0.75（95％CI：0.69~0.80）和0.80（95％CI：0.77~0.83）,SROC AUC为0.870（95％CI：0.817~0.923）;WBC的汇总敏感度和特异度分别为0.48（95％CI：0.41~0.55）和0.54（95％CI：0.51~0.58）,AUC为0.484（95％CI：0.440~0.663）;ANC的汇总敏感度和特异度分别为0.30（95％CI：0.21~0.40）和0.78（95％CI：0.73~0.83）。②平均热程24~48 h对SBIs的诊断价值：PCT的汇总敏感度和特异度分别为0.86（95％CI：0.79~0.91）和0.63（95％CI：0.60~0.67）,AUC为0.857（95％CI：0.761~0.953）;WBC的汇总敏感度和特异度分别为0.54（95％CI：0.44~0.65）和0.46（95％CI：0.41~0.51）,AUC为0.558（95％CI：0.479~0.636）;ANC的汇总敏感度和特异度分别为0.47（95％CI：0.28~0.66）和0.12（95％CI：0.08~0.17）。③平均热程>48 h对SBIs的诊断价值：PCT 的汇总敏感度和特异度分别为0.83（95％CI：0.75~0.90）和0.55（95％CI：0.50~0.59）,AUC为0.816（95％CI：0.596~0.996）;2篇WBC文献的敏感度分别为0.69（95％CI：0.41~0.89）和0.34（95％CI：0.28~0.41）,特异度分别为0.81（95％CI：0.69~0.91）和0.29（95％CI：0.24~0.35）;ANC的敏感度和特异度分别为0.87（95％CI：0.75~0.95）和0.40（95％CI：0.34~0.46）。结论 对不明原因发热儿童诊断SBIs的价值,发热<24 h检测PCT有较高的特异度;发热24~48 h检测PCT有较高的敏感度。     

应用血肌酸激酶或肌酸激酶MM同工酶筛查新生儿杜氏肌营养不良症的系统评价/Meta分析

背景：目前应用血CK或其同工酶（CK MM）筛查新生儿杜氏肌营养不良症（DMD）的临床研究较少,其准确性尚不明确。 目的：系统评价血CK或CK MM筛查新生儿DMD的准确性。 设计：系统评价/Meta分析。 方法：检索Medline（PubMed）、Embase、Cochrane Library、Web of Science、Scopus、中国知网数据库、中国生物医学文献数据库、万方数据库和维普中文期刊全文数据库,检索起始时间均为1975年1月1日,Medline（PubMed）检索截止时间为2022年11 月5日,其他数据库检索截止时间为2022年10月5日。纳入以血CK或CK MM筛查新生儿DMD的诊断准确性研究。采用QUADAS 2量表对纳入文献进行偏倚风险及临床适用性评价;提取文献数据,应用Stata 15.0和Meta Disc 1.4软件进行Meta分析;合并敏感度、特异度、阳性似然比（PLR）、阴性似然比(NLR)、诊断比值比(DOR),并绘制综合受试者工作特征曲线（SROC）,计算AUC和Q指数值。 主要结局指标：敏感度和特异度。 结果：CK筛查DMD纳入11篇文献,共1 351 953例新生儿;敏感度97%（95%CI:88%～99%）,特异度100%（95%CI:100%～100%）,PLR 1 131（95%CI:370～3 455）,NLR 0.01（95%CI:0.00～0.19）,DOR 16 476 (95%CI:4 115~65 963),AUC为0.995 4,Q指数为0.974 0;Deeks检验P=0.12,发表偏倚的可能较小。CK MM筛查DMD纳入5篇文献,共156 547例新生儿;敏感度和特异度均为100%（95%CI:100%~100%）,PLR 3 925（95%CI: 3 925~3 925）,NLR 0.00（95%CI:0.00~0.00）,DOR 23 094 (95%CI:5 773~92 384);AUC为0.925 2,Q指数为0.859 4。 结论:应用血CK或CK MM筛查新生儿DMD的准确性高,有助于早期诊断DMD。     

外周血IL-6对新生儿脓毒症诊断价值的Meta分析

目的 系统评价外周血IL-6对新生儿脓毒症的诊断价值。方法 通过计算机检索中国知网、维普、万方、PubMed、Embase、Web of Science、Cochrane 图书馆公开发表的有关文献,检索时间截止至2014年9月。采用QUADAS量表对纳入文献进行质量评估;采用Metadisc1.4及Stata11.0软件进行异质性检验并根据异质性结果选择相应的效应模型进行定量合成;计算敏感度、特异度及其95%CI,绘制汇总受试者工作特征曲线(SROC),并计算曲线下面积(AUC)及Q*指数。结果 共计33篇文献纳入Meta分析,分析结果显示:外周血IL-6对新生儿脓毒症诊断的敏感度和特异度分别为0.79(95%CI:0.76~0.81)和0.83(95%CI:0.81~0.85),SROC的AUC为0.89,Q*指数为0.83;IL-6不增高时新生儿脓毒症发生概率为5%,IL-6增高时新生儿脓毒症发生概率提高为60%。结论 外周血IL-6对新生儿脓毒症诊断的敏感度和特异度较高,有助于早期诊断新生儿脓毒症。     

Validating and updating a prediction rule for serious bacterial infection in patients with fever without source

AIM: To externally validate and update a previously developed rule for predicting the presence of serious bacterial infections in children with fever without apparent source. METHODS: Patients, 1-36 mo, presenting with fever without source, were prospectively enrolled. Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis/ethmoiditis. The generalizability of the original rule was determined. Subsequently, the prediction rule was updated using all available data of the patients with fever without source (1996-1998 and 2000-2001, n = 381) using multivariable logistic regression. RESULTS: the generalizability of the rule appeared insufficient in the new patients (n = 150). In the updated rule, independent predictors from history and examination were duration of fever, vomiting, ill clinical appearance, chest-wall retractions and poor peripheral circulation (ROC area (95%CI): 0.69 (0.63-0.75)). Additional independent predictors from laboratory were serum white blood cell count and C-reactive protein, and in urinalysis > or = 70 white bloods (ROC area (95%CI): 0.83 (0.78-0.88). CONCLUSIONS: A previously developed prediction rule for predicting the presence of serious bacterial infection in children with fever without apparent source was updated. Its clinical score can be used as a first screening tool. Additional laboratory testing may specify the individual risk estimate (range: 4-54%) further.     

Predicting serious bacterial infection in young children with fever without apparent source

The aim of this study was to design a clinical rule to predict the presence of a serious bacterial infection in children with fever without apparent source. Information was collected from the records of children aged 1-36 mo who attended the paediatric emergency department because of fever without source (temperature > or = 38 degrees C and no apparent source found after evaluation by a general practitioner or history by a paediatrician). Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis and ethmoiditis. Using multivariate logistic regression and the area under the receiver operating characteristic curve (ROC area), the diagnostic value of predictors for serious bacterial infection was judged, resulting in a risk stratification. Twenty-five percent of the 231 patients enrolled in the study (mean age 1.1 y) had a serious bacterial infection. Independent predictors from history and examination included duration of fever, poor micturition, vomiting, age, temperature < 36.7 degrees C or > or = 40 degrees C at examination, chest-wall retractions and poor peripheral circulation (ROC area: 0.75). Independent predictors from laboratory tests were white blood cell count, serum C-reactive protein and the presence of >70 white blood cells in urinalysis (ROC area: 0.83). The risk stratification for serious bacterial infection ranged from 6% to 92%. CONCLUSION: The probability of a serious bacterial infection in the individual patient with fever without source can be estimated more precisely by using a limited number of symptoms, signs and laboratory tests.     

中国川崎病患儿并发冠状动脉病变高危因素的Meta分析

目的 探讨中国川崎病患儿并发冠状动脉病变的高危因素.方法 检索包括中国学术文献总库、中文科技期刊数据库、万方期刊及学位论文数据库、中国生物医学文献数据库,并辅以文献追溯、手工检索等方法,收集2000年1月至2009年12月国内公开发表的文章和学位论文中关于川崎病并发冠状动脉病变高危因素的临床资料,对所纳入的研究数据采用Coehrane协作网提供的Review Manager软件(Revman4.2)进行统计分析.根据文献异质性检验结果,进行固定效应模型或随机效应模型的Meta分析.计算各指标的比值比(OR)及其95%的可信区间(CI).结果 共纳入文献20篇,提取资料行统计分析结果示:发病年龄≤1岁[OR=1.58,95%CI(1.23,2.04),P=0.0004],男性[OR=1.48,95%CI(1.29,1.71),P＜0.000 01],WBC＞20×109/L[OR=1.73,95%CI(1.32,2.26),P＜0.0001],CRP＞100 mg/L[OR=2.37,95% CI(1.49,3.77),P=0.0003],发热＞10 d[OR=3.23,95%CI(2.08,5.02),P＜0.000 01],丙种球蛋白使用时发病时间＞10 d[OR=2.50,95%CI(1.98,3.16),P＜0.000 01],差异均有统计学意义.ESR＞100 mm/1 h[OR=1.34,95%CI(1.02,1.75),P=0.03],差异有统计学意义,但结论不稳定.PLT＜300×109/L[OR=0.85,95%CI(0.62,1.15),P=0.29],差异无统计学意义.结论 目前中国川崎病患儿发生冠状动脉病变的主要高危因素为发病年龄≤1岁、性别为男性、WBC＞20×109/L、CRP＞100 mg/L、发热天数＞10 d、丙种球蛋白使用时发病时间＞10 d.

Abstract：

Objective Coronary artery lesion (CAL)is a serious complication of Kawasak disease (KD).Whether there is CAL and the severity arc the most critical factors of the prognosis of KD.The incidence of KD is currently increasing year by year.KD has replaced rheumatic fever as the main entity of acquired heart disease of children.This study aimed to identify risk factors of CAL secondary to KD and take early interventions to prevent CAL or reduce its incidence.MethOd Literature search was performed at Chinese Academic Literature Main Database,Chinese Science and Technology Periodical Database,Wanfang Periodicals and Dissertation Database.and the Chinese Biomedical Literature Database comprehensively,besides,retrospective retrieval and manual retrieval were also performed from the domestic public actions and the dissertations dating from January,2000 to December, 2009.RayMan 4.2 provided by Cochrane was used for meta analysis.Fixed or random model was selected according to the results of heterogeneity test.Sensitivity analysis was done according to the different results.The publication bias was evaluated by funnel plots.Odds ratio(OR)and 95% confidence interval(CI)were estimated in the dissertation.Result Twenty studies were confirmed to be eligible.A11 the 20 studies were retrospective.OR and 95%CI of the risk factors were as follows:age≤1 year,OR=1.58,and 95%CI(1.23,2.04),P=0.0004;male gender, OR=1.48,95%CI(1.29,1.71),P＜0.000 01;WBC＞20×109/L,OR=1.73,95% CI(1.32,2.26),P＜0.000l;C-reactive protein(CRP)＞100 mg/L,OR=2.37,95%CI(1.49,3.77),P=0.0003:fever duration＞10 d,OR=3.23,95%CI(2.08,5.02),P＜0.000 01;use of intravenous gamma globulin(IVIG)＞10 d,OR=2.50,95%CI(1.98,3.16),P＜0.000 01.Conclusion The high risk factors for coronary artery lesion secondary to Kawasaki disease are age≤1 year,male,WBC＞20×109/L,CRP＞100 mg/L,fever duration＞10 d,and use of intravenous gamma globulin(IVIG)＞10 d.     

Procalcitonin and C-reactive protein as diagnostic markers of severe bacterial infections in febrile infants and children in the emergency department

OBJECTIVE: To assess the value of procalcitonin (PCT) and C-reactive protein (CRP), compared with that of total white-blood cell count (WBC) and absolute neutrophil count (ANC), in predicting severe bacterial infections (SBIs) in febrile children admitted to Emergency Department. METHODS: A prospective study was conducted in 408 children aged 7-days to 36-months, admitted with fever without source, at a tertiary care Pediatric Emergency Department. PCT, CRP, WBC, and ANC were determined upon admission and compared. Specificity, sensitivity, multilevel likelihood ratios, receiver operating characteristic (ROC) analysis, and multivariate stepwise logistic regression were carried out. RESULTS: SBI was diagnosed in 94 children (23.1%). PCT, CRP, WBC, and ANC were significantly higher in this group than in non-SBI patients. The area under the ROC (AUC) obtained was 0.82 (95% CI: 0.78-0.86) for PCT, 0.85 (95% CI: 0.81-0.88) for CRP (P = 0.358), 0.71 (95% CI: 0.66-0.75) for WBC, and 0.74 (95% CI: 0.70-0.78) for ANC. Only PCT (OR: 1.32; 95% CI: 1.11-1.57; P < 0.001) and CRP (OR: 1.02; 95% CI: 1.01-1.03; P < 0.001) were retained as significant predictors of SBI in a multiple regression model. For infants with fever <8 hours (n = 45), AUC for PCT and CRP were 0.92 (95% CI: 0.80-0.98) and 0.75 (95% CI: 0.60-0.87), respectively (P = 0.056). CONCLUSION: Both PCT and CRP are valuable markers in predicting SBI in children with fever without source and they perform better than WBC and ANC. PCT appears more accurate at the beginning of infections, but overall CRP may be the most convenient marker for its better sensitivity and feasibility.     

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??Objective??To explore the clinical characteristics of coinfections in children with pertussis. Methods??From February 2016 to September 2017??198 cases with pertussis-like symptom were tested for PCR??bacterial culture??respiratory virus antigen and serum mycoplasma pneumoniae antibody in Children’s Hospital of Soochow University. Results??Totally 198 patients were enrolled and 105 patients were B.Pertussis positive. Single infection was in 37 cases??35.2%??. Coinfections were observed in 68??64.8%?? children with pertussis??including co-infection with one pathogen in 51 cases??75.0%??. The most frequent co-infection pathogen was rhinovirus??50.9%??26 cases????followed by Mycoplasma pneumoniae??13.7%??7 cases?? and Streptococcus pneumoniae??11.8%??6 cases??. There was no statistical difference in the coinfection rate among different age groups??P = 0.08??. Pertussis coinfection with MP was increased with age. Coinfections patients were older than those with single infections???11.77±2.32?? months vs. ??6.74±8.07?? months??P = 0.017??. Fever??dyspnea??and positive signs of lung in chest imang were more common in children with mixed infections??0 vs. 10.3%??20.6% vs. 5.4%??76.5% vs. 36.4%??P??0.05??. Chest imaging showed pathy shadow in most cases. There was no significant difference in lab tests??such as white blood cell counts??neutrophil counts??C-reactive protein??CRP????course of disease prior to admission or hospital stay between patients with pertussis only and those with mixed-pathogen infections??P??0.05??. Patients older than 3 months??OR??3.0??95%CI 1.1-8.5??P??0.03?? and fever??OR??2.5??95%CI 1.1-6.7??P??0.03?? were the independent risk factors for mixed infections. Conclusion??There is a higher proportion of coinfection in hospitalized children with pertussis??most commonly co-infected with rhinovirus??followed by Mycoplasma pneumoniae and Streptococcus pneumoniae. Coinfections are found to aggravate pertussis. Fever and being older than 3 months are risk factors of mixed infection.     

Procalcitonin. A new marker for bacterial infection

Procalcitonin is a polypeptide present in the plasma of healthy subjects in minimal levels (< 0.5 ng/ml). Serum procalcitonin is markedly increased a few hours after the administration of endotoxin to human volunteers and in invasive bacterial infection (sepsis, septic shock, meningitis). Procalcitonin is moderately increased in local bacterial infection (pneumonia pyelonephritis) and is unchanged in viral infections or bacterial colonization. Procalcitonin is increased in serious bacterial infections in neonates, children and adults and is currently the best diagnostic marker of severe bacterial infection, being better than leukocyte, interleukin or C-reactive protein counts. C-reactive protein levels can be normal in severe sepsis and some viral infections. We studied 54 children with sepsis in whom plasma procalcitonin levels showed a positive correlation with the vasoactive drugs necessary to maintain cardiovascular activity. The semiquantitative procalcitonin test is simple and easy to use at the bedside at any time and in any hospital as no instruments are required. Within 30 minutes, the test identifies the type of infection and whether antibiotics are indicated.     

Is procalcitonin useful in early diagnosis of serious bacterial infections in children?

AIM: To compare diagnostic accuracy of procalcitonin for early diagnosis of serious bacterial infection (SBI) in children presenting with fever and no focus of infection. METHODS: Prospective, observational study involving 72 children (1-36 mo) presenting to the paediatric units of two university hospitals. All children had blood cultures, urine cultures, white blood cell counts (WBC), chest X-ray, C-reactive protein (CRP) and procalcitonin (PCT) done at presentation. RESULTS: Eight (11.1%) children had SBI (1 pneumonia, 2 meningitis, 4 septicaemia/occult bacteraemia, 2 pyelonephritis), 19 (26.4%) had possible bacterial infection (received antibiotic treatment, but no organism grown) and 45 (62.5%) had viral or possible viral infection (virus isolated and/or uneventful recovery without antibiotics). PCT (>2 ng/l), CRP (>50 mg/l) and McCarthy's score (<9) had sensitivities and specificities of 50%/85.9%, 75%/68.7% and 87.5%/67.2%, respectively. Negative and positive likelihood ratios for CRP (>50 mg/l), PCT (>2 ng/l), white blood cells (>15 x 10(5)/l) and McCarthy's score (<9) were 0.36/2.4, 0.58/3.5, 0.94/1.1 and 0.19/2.7, respectively. A combination of PCT, CRP and WBC generated a positive likelihood ratio of 10.6, changing the post-test probability to 54%. CONCLUSION: For early diagnosis of SBI in children presenting with fever and no focus of infection, the diagnostic utility of procalcitonin is similar to the traditional markers infection and clinical scoring. While a low procalcitonin level cannot be used to exclude SBI in this population, a combination of PCT, CRP and WBC may be more useful in predicting SBI.     

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??Objective??To investigate the clinical features and risk factors of multidrug-resistant bloodstream infection in children with acute leukemia. Methods??The clinical data of 121 blood culture-positive patients with acute leukemia admitted from January 1??2013 to September 30??2018 to Department of Pediatrics??Zhujiang Hospital of Southern Medical University were analyzed retrospectively. Results??Of the 121 patients with acute leukemia infected with bacterial bloodstream??55 were in the multidrug-resistant??MDR?? group and 66 in the non-multidrug-resistant??non-MDR?? group. There were 31 gram-positive bacteria in the MDR group. The top three strains were coagulase-negative Staphylococci??Staphylococcus aureus and Streptococcus mutans. Escherichia coli was the main strain of gram-negative bacteria. Logistic analysis suggested that MDR bloodstream infection was more likely to occur in the patiens with AML??P??0.038??OR 2.505??95%CI 1.036—6.058?? and at induction chemotherapy stage??P??0.038??OR 2.226??95%CI 1.045—4.774??. Other high-risk factors included neutropenic dysplasia ??7 d before fever??P??0.003??OR 3.36??95%CI 1.520—7.428????hemoglobin ??70 g/L??P??0.122??OR 1.897??95%CI 0.842—4.274????and platelet??20 g/L??P??0.005??OR 2.995??95%CI 1.388—6.464??. The fever duration and antibiotic course in the MDR group were longer than those in the non-MDR group??and the procalcitoni and C-reactive protein were higher in the MDR group. The empirical treatment of the MDR group was less effective??and the transfer rate for ICU and mortality rate were higher. Conclusion??AML??induction chemotherapy??neutrophil deficiency time before fever ??7 days ??hemoglobin??70 g/L and platelet??20×109/L are risk factors for MDR bloodstream infection. The inflammation response is severe MDR bloodstream infections??which may result in longer anti-infective treatments and a worse prognosis.