Procalcitonin as an early marker of infection in neonates and children

Defining urinary tract infection in the critically ill child

OBJECTIVE

To define urinary tract infections in critically ill children in the intensive care unit setting for the purpose of surveillance of infection, enrollment of children in sepsis trials, and for trials of therapy and prevention.

DESIGN

Summary of the literature with review and consensus by experts in the field.

RESULTS

A variety of definitions, only some of which have been validated for use in children, were identified. The Centers for Disease Control criteria for the definition of nosocomial infection have been used to establish surveillance data for inter-institutional comparison. Validated definitions for the febrile child were identified. Using the known characteristics of symptoms, signs, and laboratory criteria for urinary tract infections, definitions for definite, possible, and probable urinary tract infection were derived.

CONCLUSIONS

Definitions for definite, probable, and possible urinary tract infection were achieved by consensus that can be used for surveillance and enrolment in sepsis trials. Future research should determine the utility of these definitions in the critically ill child and adapt them accordingly.

Evaluation of a rapid bedside test for the quantitative determination of C-reactive protein

Regardless of its origin, any condition associated with inflammation is accompanied by an increase in serum C-reactive protein levels. This study compared the results of a rapid test for the bedside assay of C-reactive protein (QuikRead CRP, Orion Corporation, Orion Diagnostica, Espoo, Finland) with those of a standard laboratory assay in samples taken from 231 children aged less than 14years (126 males; median age 4.7years) attending the Emergency Department of Milan University's Institute of Pediatrics because of acute respiratory infection. The two methods showed similar median C-reactive protein levels (standard laboratory assay: 34.7mg/L, range 4–199mg/L; QuikRead CRP: 33.3mg/L, range <8–196mg/L; p=0.779) and a similar distribution of children with C-reactive protein levels of <20mg/L, 20–70mg/L and >70mg/L. This study shows for the first time that the rapid QuikRead CRP test can be performed at the bedside or in an outpatient clinic and, in less than 5min, gives the same quantitative results as those obtained using a more complex routine laboratory method.