Procalcitonin performance in detecting serious and invasive bacterial infections in children with fever without apparent source: a systematic review and meta-analysis

<p><b>Introduction</b>: The management of children with fever without apparent sources (FWAS) is difficult. This study aimed to evaluate the diagnostic accuracy of procalcitonin (PCT) in detecting serious or invasive bacterial infection (SBI or IBI) in children with FWAS.</p> <p><b>Areas covered</b>: A systematic review of literature from 2007 to 2017 was performed on Medline. Twelve studies were included, involving 7,260 children with FWAS and analyzing the diagnostic performance of PCT. Four meta-analyses were performed to calculate pooled sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve for PCT in detecting SBI and IBI, at two different thresholds. Considering IBI, PCT sensitivity and specificity at a threshold of 0.5 ng/mL were 0.82 and 0.86, respectively; at a threshold of 2 ng/mL sensitivity and specificity were 0.61 and 0.94, respectively. In detecting SBI, PCT performance was lower, with 55% sensitivity and 85% specificity at a threshold of 0.5 ng/mL, and 30% sensitivity and 95% specificity at a threshold of 2 ng/mL.</p> <p><b>Expert commentary</b>: Considering IBI, results showed high diagnostic accuracy for PCT. Conversely, PCT performance in diagnosis of SBI was poor. These findings suggest that PCT level determination could be helpful in detecting meningitis, bacteremia and sepsis in children with FWAS.</p

Risk factors associated with complications/sequelae of acute and subacute haematogenous osteomyelitis: an Italian multicenter study

<p><b>Background</b>: Acute/subacute haematogenous osteomyelitis (AHOM/SAHOM) are potentially devastating diseases. Updated information about the epidemiology, management and outcome of AHOM/SAHOM is needed to minimize the risk of complications and sequelae.</p> <p><b>Methods</b>: A multicenter study was performed to evaluate retrospectively the management and outcome of AHOM/SAHOM in Italy. Data from children aged >1 month, and hospitalized between 2010 and 2016, in 19 pediatric centers, were analyzed.</p> <p><b>Results</b>: 300 children with AHOM and 98 with SAHOM were included. Median age was 6.0 years (IQR: 2.0–11.0). No clinical difference was observed with the exception of fever at onset (63.0% <i>vs</i>. 42.9%; P < 0.0001), and a more common spinal involvement in SAHOM (6.7% vs 20.4%; P < 0.001). Fifty-Eight <i>Staphylococcus aureus</i> strains were isolated; 5 (8.6%) were MRSA. No <i>Kingella kingae</i> infection was documented. No different risk for complication/sequela was observed between AHOM and SAHOM (38.3% <i>vs</i>. 34.7%; OR:0.85; 95%CI: 0.53–1.38; P = 0.518). Duration and type of antibiotic therapy were not associated with risk of complication/sequelae.</p> <p><b>Conclusion</b>: AHOM and SAHOM displayed some differences, however occurrence and risk factors for complications and sequelae are similar, and the same empiric treatment might be recommended.</p