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Role of Serum Procalcitonin in Monitoring the Response to Treatment of Pediatric Bacterial Meningitis

Background: Early diagnosis and appropriate management are important to reduce the complications of acute bacterial meningitis (ABM). Serum procalcitonin (PCT) is one of the most sensitive and specific markers for identification of ABM. Objective: This study was done to evaluate serum PCT as a marker to confirm ABM especially after oral antibiotics intake or when cerebrospinal fluid (CSF) culture is negative and to assess its correlation with outcome of ABM in children. Methods: This is a prospective cohort study that included 38 children with suspected ABM who presented to Ain Shams University Children Hospital over a period of 6 months. The PCT levels were measured on admission and 72 hours (h) after treatment. Results: Sixteen cases received oral antibiotics before admission, out of which only 6 (38%) patients showed growth in CSF bacterial culture. All the 38 cases showed elevated levels of PCT on admission. There was a significant drop in the mean of PCT level after 72 h of treatment compared to level on admission (7.1±6.5 vs. 11.4±3.7, p=0.001) respectively. There was a significant difference in the mean of PCT level between cases with good versus poor outcome, on admission (7.2±2.8 vs. 13.2±4.4, p<0.001) and 72 h after treatment (4.2±3.5 vs. 12.9±5.3, p<0.001) respectively. Conclusion: Serum PCT levels were high in all patients with suspected ABM, including those who received oral antimicrobials for 1-3 days before admission. The decline in PCT levels after treatment was associated with favorable outcome in our cohort.