Utility of Procalcitonin and C-reactive protein in diagnosing patients with urinary tract infections

Abstract Background Procalcitonin (PCT) and c-reactive protein (CRP) have been utilized in children to assess risk for serious bacterial infections. However, there have been different cut-offs reported for PCT and CRP, which yield different sensitivity and specificity. This study aims to compare the sensitivity and specificity of PCT and CRP in detecting serious bacterial infections (SBIs), specifically urinary tract infections, bacteremia and meningitis. Methods In this retrospective, single center cohort study from January 2018 to June 2019, we analyzed children with a fever greater than 38C with both PCT and CRP value within 24 hours of admission. Each patient had a blood, urine and/or cerebrospinal fluid culture collected within 48 hours of admission. No antibiotics were administered from the admitting hospital prior to collection of the PCT or CRP. Our gold standard was a positive culture obtained from blood, cerebrospinal fluid, or urine. The statistical analysis included categorical variables as percentages and compared them using the Fisher exact test. The optimal cutoff values for PCT or CRP were based on ROC curve analysis and Youden Index. Sensitivity and specificity analysis were based on literature review cut offs and ROC curves cut offs. Results Among 202 children, we had 45 culture positive patients (11 urinary tract infections, 4 meningitis, and 32 bacteremia). The patients with culture positivity had higher PCT levels (7.9 ng/mL vs 2.5 ng/mL, P=0.0111), CRP levels (110.9 mg/L vs 49.6 mg/L, P<0.0001) and temperature (39.2C vs 39C, P<0.0052). The area under the curve (AUC) comparing culture positivity vs negativity for all culture types was 0.72 (p<0.0001) for PCT and 0.66 (p=0.001) for CRP. In Figure 1, the AUC for culture positive bacteremia was 0.68 (p=0.0011) for PCT and 0.70 (p=0.0003). The AUC for culture positive urinary tract infections (UTI) only was 0.86 (p=0.0001) for PCT and 0.70 (p=0.3607). For the cut-off value for PCT at 0.5 ng/mL, the sensitivity and specificity was 64% (95% confidence interval [CI] 0.5–0.77) and 70% (95% CI 0.62–0.77) respectively in identifying children with bacterial infection. For the cut-off value for CRP at 20 mg/L, the sensitivity and specificity was 67% (95% CI 0.52–0.79) and 52% (95% CI 0.44–0.59) respectively in identifying children with bacterial infection. Conclusion In this study, PCT and CRP are nearly equivalent classifiers for detecting SBIs as a group and bacteremia, but PCT is statistically better for urinary tract infections; however, the clinical utility is unknown.

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Localization and Therapy of Urinary Tract Infections of Childhood

PEDIATRICS ◽

10.1542/peds.63.3.467 ◽

1979 ◽

Vol 63 (3) ◽

pp. 467-474 ◽

Cited By ~ 1

Author(s):

Raoul L. Wientzen ◽

George H. McCracken ◽

Mary L. Petruska ◽

Susan G. Swinson ◽

Bertil Kaijser ◽

...

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

Pediatric Patients ◽

Clinical Presentation ◽

C Reactive Protein ◽

E Coli ◽

Reactive Protein ◽

Tract Infections ◽

Antibody Coating

One hundred four patients with 124 episodes of urinary tract infection were studied. Serum C-reactive protein (CRP) was determined on diagnosis of each patient. Children with a CRP equal to or greater than 30 µg/ml (CRP-pos) differed significantly from those with values less than 30 µ/ml (CRP-neg) in age, clinical presentation, K type of Escherichia coli causing disease, frequency or radiographic abnormalities, and presence of antibody coating of bacteria in the urinary sediment. E coli K1 strains caused disease significantly more often in CRP-pos than in CRP-neg patients, and children with K1 infections were younger than those with non-K1 infections. The antibody-coated bacteria test was neither sensitive nor specific for localization of infection in pediatric patients. Determination of K1 antibody concentrations in serum and urine of E coli K1-infected children provided data supporting the measurement of CRP as one means of localizing urinary tract infections. Patients with CRP-neg infections were treated as successfully with four days of antimicrobial therapy as with ten days.

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Sensitivity of C-Reactive Protein and Procalcitonin Measured by Point-of-Care Tests to Diagnose Urinary Tract Infections in Nursing Home Residents: A Cross-Sectional Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1709 ◽

2020 ◽

Author(s):

S D Kuil ◽

S Hidad ◽

J C Fischer ◽

J Harting ◽

C M P M Hertogh ◽

...

Keyword(s):

Nursing Home ◽

Urinary Tract ◽

Sample Size ◽

Urinary Tract Infections ◽

Point Of Care ◽

Nursing Home Residents ◽

C Reactive Protein ◽

Reactive Protein ◽

Tract Infections ◽

Point Of Care Tests

Abstract Background Diagnosing urinary tract infections (UTIs) in nursing home residents is complex, as specific urinary symptoms are often absent and asymptomatic bacteriuria (ASB) is prevalent. The aim of this study was to assess the sensitivity of blood C-reactive protein (CRP) and procalcitonin (PCT), measured by point-of-care tests (PoCTs), to diagnose UTIs in this setting. Methods Elderly residents (≥65 years old) with a suspected UTI were recruited from psychogeriatric, somatic, or rehabilitation wards across 13 participating nursing homes. CRP and PCT were tested simultaneously in the same study participants. To assess the tests’ sensitivities, a stringent definition of “true” UTI was used that included the presence of symptoms, urinary leucocytes, a positive urine culture, and symptom resolution during antibiotic treatment covering isolated uropathogen(s). The original sample size was 440 suspected UTI episodes, in order to detect a clinically relevant sensitivity of at least 65% when calculated using the matched analysis approach to compare both PoCTs. Results After enrollment of 302 episodes (68.6% of the planned sample size), an unplanned and funder-mandated interim analysis was done, resulting in premature discontinuation of the study for futility. For 247 of 266 eligible episodes, all mandatory items required for the true UTI definition (92.9%) were available. In total, 49 episodes fulfilled our stringent UTI definition (19.8%). The sensitivities of CRP (cut-off, 6.5 mg/L) and PCT (cut-off, 0.025 ng/mL) were 52.3% (95% confidence interval [CI], 36.7–67.5%) and 37.0% (95% CI, 23.2–52.5%), respectively. Conclusions Our results indicate that CRP and PCT are not suitable tests for distinguishing UTI and ASB in nursing home residents. Clinical Trials Registration Netherlands Trial Registry NL6293.

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1505 LOCALIZATION OF THE SITE OF URINARY TRACT INFECTIONS USING SERUM C-REACTIVE PROTEIN (CRP)

Pediatric Research ◽

10.1203/00006450-198104001-01528 ◽

1981 ◽

Vol 15 ◽

pp. 694-694 ◽

Cited By ~ 5

Author(s):

Stanley Hellerstein ◽

Eileen Duggan ◽

Eleanor Welchert ◽

Fayzeh Mansour

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

C Reactive Protein ◽

Reactive Protein ◽

Tract Infections

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Usefulness of procalcitonin and C-reactive protein for predicting bacteremia in urinary tract infections in the emergency department

Actas Urológicas Españolas (English Edition) ◽

10.1016/j.acuroe.2015.07.011 ◽

2015 ◽

Vol 39 (8) ◽

pp. 502-510 ◽

Cited By ~ 1

Author(s):

A. Julián-Jiménez ◽

P. Gutiérrez-Martín ◽

A. Lizcano-Lizcano ◽

M.A. López-Guerrero ◽

Á. Barroso-Manso ◽

...

Keyword(s):

Emergency Department ◽

Urinary Tract ◽

Urinary Tract Infections ◽

C Reactive Protein ◽

Reactive Protein ◽

Tract Infections

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Serum C-reactive protein and the site of urinary tract infections

The Journal of Pediatrics ◽

10.1016/s0022-3476(82)80229-1 ◽

1982 ◽

Vol 100 (1) ◽

pp. 21-25 ◽

Cited By ~ 32

Author(s):

Stanley Hellerstein ◽

Eileen Duggan ◽

Eleanor Welchert ◽

Fayzeh Mansour

Keyword(s):

Urinary Tract ◽

Urinary Tract Infections ◽

C Reactive Protein ◽

Reactive Protein ◽

Tract Infections

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Sensitivity of point-of-care testing C reactive protein and procalcitonin to diagnose urinary tract infections in Dutch nursing homes: PROGRESS study protocol

BMJ Open ◽

10.1136/bmjopen-2019-031269 ◽

2019 ◽

Vol 9 (8) ◽

pp. e031269 ◽

Cited By ~ 4

Author(s):

Sacha D Kuil ◽

Soemeja Hidad ◽

Johan C Fischer ◽

Janneke Harting ◽

Cees MPM Hertogh ◽

...

Keyword(s):

Urinary Tract ◽

Nursing Homes ◽

Study Protocol ◽

Point Of Care ◽

Asymptomatic Bacteriuria ◽

C Reactive Protein ◽

Reactive Protein ◽

Reference Number ◽

Tract Infections ◽

Clinical Rules

IntroductionSuspected urinary tract infection (UTI) ranks among the most common reasons for antibiotic use in nursing homes. However, diagnosing UTI in this setting is challenging because UTI often presents with non-specific symptomatology. Moreover asymptomatic bacteriuria is common in elderly, which complicates attribution of causality to detection of bacteria in urine. These diagnostic challenges contribute to overuse of antibiotics and emergence of antimicrobial resistance in nursing homes. Given the diagnostic challenges, there is a need for point-of-care (POC) diagnostic tests to support clinical rules for diagnosing UTI. Procalcitonin (PCT) and C reactive protein (CRP) are inflammatory blood markers that have been proven useful to support diagnosis and monitoring of (bacterial) respiratory tract infections and sepsis. While limited studies suggest their usefulness in supporting UTI diagnosis, their utility has not been studied in elderly populations for this purpose.Methods and analysisIn a 24-month matched prospective study, ‘PROGRESS’ will assess and compare the sensitivity of rapid POC measurements of blood CRP and PCT levels to support clinical rules for diagnosing UTI in nursing home residents. The primary outcome measure is sensitivity of the POC tests to identify patients with true UTI based on the predefined definition, as derived from receiver operating curves.Ethics and disseminationThis study will be conducted in accordance with Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. The study protocol is approved by the Medical Ethical Committee of Amsterdam UMC location VUmc with reference number 2017.350 and National Central Committee on Research involving Human Subjects with reference number NL62067.029.17.Trial registration numberNTR6467.

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C - reactive protein and urinary tract infection due to Gram-negative bacteria in a pediatric population at a tertiary hospital, Mwanza, Tanzania

African Health Sciences ◽

10.4314/ahs.v19i4.45 ◽

1970 ◽

Vol 19 (4) ◽

pp. 3217-3224

Author(s):

Martha F Mushi ◽

Vaileth G Alex ◽

Mwanaisha Seugendo ◽

Vitus Silago ◽

Stephen E Mshana

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Enteric Bacteria ◽

Gram Negative Bacteria ◽

C Reactive Protein ◽

Gram Negative ◽

Reactive Protein ◽

Significant Bacteriuria ◽

Tract Infections

Introduction: Gram-negative bacteria are the major cause of urinary tract infections (UTI) in children. There is limited data on UTI systemic response as measured using C-reactive protein (CRP). Here, we report the association of CRP and UTI among children attending the Bugando Medical Centre, Mwanza, Tanzania.Methods: A cross-sectional study was conducted between May and July 2017. Urine and blood were collected and processed within an hour of collection. Data were analyzed using STATA version 13.Results: Of 250 enrolled children, 76(30.4%) had significant bacteriuria with 56(22.4%, 95%CI; 11.5-33.3) having gram-negative bacteria infection. There was dual growth of gram-negative bacteria in 3 patients. Escherichia coli (32.2%, 19/59) was the most frequently pathogen detected. A total of 88/250(35.2%) children had positive CRP on qualitative assay. By multinomial logistic regression, positive CRP (RRR=4.02, 95%CI: 2.1-7.7, P<0.001) and age ≤ 2years (RRR=2.4, 95%CI: 1.23-4.73, P<0.01) significantly predicted the presence of significant bacteriuria due to gram-negative enteric bacteria. Conclusion: C-reactive protein was significantly positive among children with UTI due to gram-negative bacteria and those with fever. In children with age ≤ 2 years, positive CRP indicates UTI due to gram-negative enteric bacteria.Keywords: C - reactive protein, urinary tract infection, Gram-negative bacteria, Mwanza, Tanzania.

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Diagnostic value of biomarkers for paediatric urinary tract infections in primary care: systematic review and meta-analysis

BMC Family Practice ◽

10.1186/s12875-021-01530-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hanne A. Boon ◽

Thomas Struyf ◽

Dominique Bullens ◽

Ann Van den Bruel ◽

Jan Y. Verbakel

Keyword(s):

Systematic Review ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Meta Analysis ◽

Clinical Prediction ◽

C Reactive Protein ◽

Dipstick Test ◽

Prediction Rules ◽

Reactive Protein ◽

Tract Infections

Abstract Background Accurate diagnosis of urinary tract infection is essential as children left untreated may suffer permanent renal injury. Aim To compare the diagnostic values of biomarkers or clinical prediction rules for urinary tract infections in children presenting to ambulatory care. Design and setting Systematic review and meta-analysis of ambulatory care studies. Methods Medline, Embase, WOS, CINAHL, Cochrane library, HTA and DARE were searched until 21 May 2021. We included diagnostic studies on urine or blood biomarkers for cystitis or pyelonephritis in children below 18 years of age. We calculated sensitivity, specificity and likelihood ratios. Data were pooled using a bivariate random effects model and a Hierarchical Summary Receiver Operating Characteristic analysis. Results Seventy-five moderate to high quality studies were included in this review and 54 articles in the meta-analyses. The area under the receiver-operating-characteristics curve to diagnose cystitis was 0.75 (95%CI 0.62 to 0.83, n = 9) for C-reactive protein, 0.71 (95% CI 0.62 to 0.80, n = 4) for procalcitonin, 0.93 (95% CI 0.91 to 0.96, n = 22) for the dipstick test (nitrite or leukocyte esterase ≥trace), 0.94 (95% CI 0.58 to 0.98, n = 9) for urine white blood cells and 0.98 (95% CI 0.92 to 0.99, n = 12) for Gram-stained bacteria. For pyelonephritis, C-reactive protein < 20 mg/l had LR- of 0.10 (95%CI 0.04–0.30) to 0.22 (95%CI 0.09–0.54) in children with signs suggestive of urinary tract infection. Conclusions Clinical prediction rules including the dipstick test biomarkers can support family physicians while awaiting urine culture results. CRP and PCT have low accuracy for cystitis, but might be useful for pyelonephritis.

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Differential Serum and Urine CRP, IP-10, and TRAIL Levels in Pediatric Urinary Tract Infection

Frontiers in Pediatrics ◽

10.3389/fped.2021.771118 ◽

2021 ◽

Vol 9 ◽

Author(s):

Liat Ashkenazi-Hoffnung ◽

Gilat Livni ◽

Oded Scheuerman ◽

Itay Berger ◽

Eran Eden ◽

...

Keyword(s):

Urinary Tract ◽

Viral Infection ◽

Urine Culture ◽

Serum Levels ◽

Serum Biomarkers ◽

C Reactive Protein ◽

Reactive Protein ◽

Tract Infections ◽

Induced Changes ◽

Serum Crp

Background: It is estimated that clinical evaluation and urinalysis are unable to diagnose >10% of urinary tract infections (UTI) in young children. TNF-related apoptosis induced ligand (TRAIL), interferon gamma induced protein-10 (IP-10), and C-reactive protein (CRP) exhibit differential expression in the blood in response to bacterial vs. viral infection. We assessed if the urinary and serum levels of these host biomarkers discriminate UTI, nephronia, and response to antibiotic treatment.Methods: Hospitalized febrile children aged <18 years with suspected UTI based on abnormal urinalysis were recruited prospectively between 2016 and 2018; also, non-febrile controls were recruited. Following urine culture results and hospitalization course, participants were divided into three groups based on AAP criteria and expert adjudication: UTI, viral infection, and indeterminate.Results: Seventy-three children were enrolled, 61 with suspected UTI and 12 non-febrile controls. Of the 61 with suspected UTI, 40 were adjudicated as UTI, 10 viral infection, and 11 as indeterminate. Urinary CRP and IP-10 levels were significantly higher in the UTI group (p ≤ 0.05). Urinary CRP differentiated UTI from non-bacterial etiology in children under and over 3 months of age, with AUCs 0.98 (95% CI: 0.93–1.00) and 0.82 (0.68–0.95), respectively. Similarly, urinary IP-10 discriminated with AUCs of 0.80 (0.59–1.00) and 0.90 (0.80–1.00), respectively. Serum CRP and IP-10 levels were significantly higher in UTI cases with nephronia (p ≤ 0.03). UTI-induced changes in the levels of urinary and serum biomarkers resolved during recovery.Conclusions: CRP, IP-10, and TRAIL represent biomarkers with potential to aid the clinician in diagnosis and management of UTI.

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