Abstract Background: In pediatric intensive care unit (PICU) settings, rapid and reliable identification of bacterial lower respiratory tract infection (LRTI) using biomarkers can guide antibiotic initiation or discontinuation decisions, thereby reducing unnecessary antibiotic exposure and associated complications. Objective: This study aimed to study the utility of biomarkers and determine their role in differentiating bacterial from nonbacterial LRTI in children (2 months to 12 years) admitted in PICU. Materials and Methods: Hospital-based cross-sectional study conducted among 100 children with LRTI of age between 2 months and 12 years. Detailed clinical history, examination, blood investigations, and chest X-ray were done. Procalcitonin (PCT) levels, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) levels, and complete blood counts were done. Based on history, clinical examination, and investigations, we divided the cases into two categories: bacterial and nonbacterial LRTI. The difference in the diagnostic performances of the various biomarkers in the two groups was inferred. Results: 54% were males and 57% patients were aged 2–12 months. Positive Chest X-ray was observed in 43%. Blood culture was positive in 26%. Of the total children, 36% were diagnosed with bacterial LRTI. The association between diagnosis and outcome was not statistically significant ( P = 0.23). CRP had the maximum sensitivity in differentiating bacterial from nonbacterial LRTI, followed by Sr. PCT and ESR. Among the various biomarkers in the study, Sr. PCT had the maximum specificity, positive predictive value, negative predictive value, and diagnostic accuracy in differentiating bacterial from nonbacterial LRTI. Conclusion: Integration of biomarkers into routine clinical practice offers a promising strategy for improving the diagnosis of LRTI in children.
Tiwari et al. (Wed,) studied this question.