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Markers for bacterial infection in children with fever without source
  1. Sergio Manzano1,2,
  2. Benoit Bailey1,
  3. Alain Gervaix2,
  4. Jocelyne Cousineau3,
  5. Edgar Delvin3,
  6. Jean-Bernard Girodias1
  1. 1Department of Pediatrics, Division of Emergency Medicine, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
  2. 2Division of Emergency Medicine, Children's Hospital HUG, Geneva, Switzerland
  3. 3Department of Clinical Biochemistry, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
  1. Correspondence to Benoit Bailey, Department of Pediatrics, Division of Emergency Medicine, CHU Sainte-Justine, 3175 Chemin de la Côte-Ste-Catherine, Montréal, QC H3T 1C5, Canada; benoit.bailey{at}


Objectives To compare the diagnostic properties of procalcitonin (PCT), C reactive protein (CRP), total white blood cells count (WBC), absolute neutrophil count (ANC) and clinical evaluation to detect serious bacterial infection (SBI) in children with fever without source.

Design Prospective cohort study.

Setting Paediatric emergency department of a tertiary care hospital.

Participants Children aged 1–36 months with fever and no identified source of infection.

Intervention Complete blood count, blood culture, urine analysis and culture. PCT and CRP were also measured and SBI probability evaluated clinically with a visual analogue scale before disclosing tests results.

Outcome measure Area under the curves (AUC) of the receiver operating characteristic curves.

Results Among the 328 children included in the study, 54 (16%) were diagnosed with an SBI: 48 urinary tract infections, 4 pneumonias, 1 meningitis and 1 bacteraemia. The AUC were similar for PCT (0.82; 95% CI 0.77 to 0.86), CRP (0.88; 95% CI 0.84 to 0.91), WBC (0.81; 95% CI 0.76 to 0.85) and ANC (0.80; 95% CI 0.75 to 0.84). The only statistically significant difference was between CRP and ANC (Δ AUC 0.08; 95% CI 0.01 to 0.16). It is important to note that all the surrogate markers were statistically superior to the clinical evaluation that had an AUC of only 0.59 (95% CI 0.54 to 0.65).

Conclusion The study data demonstrate that CRP, PCT, WBC and ANC had almost similar diagnostic properties and were superior to clinical evaluation in predicting SBI in children aged 1 month to 3 years.

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  • Funding The investigators received 200 PCT-Q kits from Brahms (Germany). Reagents for the Kryptor PCT measurements were provided by Brahms (Switzerland).

  • Ethics approval This study was conducted with the approval of CHU Sainte-Justine.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.