| Objective To understand the epidemiological features of the distribution of age andseason of onset in children with community-acquired pneumonia (CAP), and explorethe value of serum procalcitonin (PCT) in guiding antibiotic therapy for children withCAP and the correlation between PCT level and the severity of disease, providing anobjective reference for the future diagnosis and treatment of children with CAP andachievement of a good prognosis.Methods Based on a prospective, randomized and controlled method,204childrenwith CAP consistent with the inclusion criteria of children CAP were enrolled. Theywere admitted in the First Affiliated Hospital of Dalian Medical University from March2012to February2014, aged between three months and12years, including114malesand90females. With the consent of the guardians, they were randomly assigned to thestandard treatment group（n=106） and the PCT-guided treatment group(n=98) by usingthe random number table method. Two groups of children underwent routine laboratorytests before the drug treatment, including white blood cell (WBC) count, C reactiveprotein (CRP) measurement, serum PCT measurement and chest radiograph. Thestandard treatment group underwent empiric therapy according to the disease andlaboratory findings of the children, while the PCT-guided treatment group underwentantibiotic treatment according to their serum PCT levels. PCT was detected by immunechemiluminescence with the LUMAT-LB9507detector made in BRAHMS Company inGerman. When PCT level was below0.25ng/ml, antibiotics were not advised to be used;when PCT level was not less than0.25ng/ml, the antibiotic treatment was recommended.If PCT level was below0.25ng/ml, a review was necessary after24h, and the results ofreview determined whether to use the antibiotics or not. For these children, PCT and other necessary indicators were reviewed every three days. When the serum PCT levelwas below0.25ng/ml in children treated with antibiotics, antibiotic treatment should bewithdrawn. Two groups of children underwent symptomatic treatment for fever, coughand phlegm. The observed indicators included age of onset, season of onset,temperature, WBC, CRP, PCT, the average thermal annealing time, the average coughdisappeared time, the average sputum disappeared time, the average pulmonary ralesdisappeared time, antibiotic usage time, antibiotic usage rate, antibiotic costs, clinicalefficacy, the severity of PCT positive rates in children with mild and severe CAP, andPCT level. Various indicators were observed and recorded before and after treatment intwo groups, and the epidemiological characteristics, clinical efficacy and treatmentconditions were compared and analyzed. SPSS20.0software was used for statisticalanalysis of the obtained data.Results1. Comparison of general data:The differences of gender, age and the diseaseseverity were not statistically significant (P＞0.05).2. Distribution of age of onset: There were94cases (46.08%) of children below oneyear,64cases (31.37%) of children between one and three years,31cases (15.20%) ofchildren between three and six years, and15cases (7.35%) of children over six years.The majority of children were below one year.3. Distribution of season of onset: There were67cases (32.84%) of children withthe onset in spring,25cases (12.25%) in summer,30cases (14.71%) in autumn, and82cases (40.20%) in winter. The majority of cases were in spring and winter.4. Comparison of clinical efficacy: The total effective rate was89.80%inPCT-guided treatment group and88.68%in the standard treatment group; the differencewas not statistically significant (P＞0.05).5. Comparison of temperature, inflammatory makers before and after treatment andcomparison of clinical features after treatment: The temperature, WBC, CRP and PCTvalues were compared before treatment between two groups, and the difference was notstatistically significant (P＞0.05). The temperature, WBC, CRP and PCT values werecompared after treatment between two groups, and the difference was not statisticallysignificant (P＞0.05). The average thermal annealing time, the average coughdisappeared time, the average sputum disappeared time, and the average pulmonary rales disappeared time were compared after treatment between two groups, and thedifference was not statistically significant (P＞0.05).6. Comparison of antibiotic usage: The usage time, usage rate and costs ofantibiotics in PCT-guided treatment group were all lower than those in the standardtreatment group, and the differences were statistically significant (P＜0.05).7. Comparison of PCT levels in mild and severe CAP: The PCT levels of childrenwith severe CAP were significantly higher than those of children with mild CAP, andthe difference was statistically significant (P＜0.05).Conclusions1. Predilection age: CAP is common in infants below three years, especially inthose below one year who have the highest incidence rates. The morbidity in the elderchildren is less than that in infants.2. Predilection season: Local children are prone to CAP in winter and spring; themorbidity in summer and autumn was less than that winter and spring.3. PCT-guided treatment of children CAP, although without significant differencesin the total effective rate, reduction of various inflammatory markers, and thedisappearance of clinical symptoms and characteristics compared with the empiricaltreatment, it can shorten the usage time of antibiotics in children, reduce the usage rateand costs of antibiotics and alleviate the financial burden of the family. Dynamicdetection of PCT level has an important reference value in guiding the rational use ofantibiotics, reducing the overuse of antibiotics, and preventing the occurrence of drugresistance.4. PCT is not only a reliable inflammatory indicator, but it also has close relationwith the severity of bacterial infection. Therefore, it is an important biological markerfor evaluation of the severity of CAP infection in children. PCT detection can assess theseverity of the disease, providing an objective reference for future clinical diagnosis andtreatment of children CAP and achievement of a good prognosis. |
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