Usefulness of acute phase reactants on distinction of viral/bacterial infections in febrile children who admitted to eütf children's hospital

Objective: This study was prepared to search superiorities and benefits of acute phase reaction in division of viral –bacterical infection and usefulness in practise of them for children ( between 1 month-18 ages) who had fever and applied to General Pediatric Policlinic and Pediatric Emergency Department of Ege University Medical Faculty. Methods: The study included 300 patients (between 1 month-18 ages) who had fever and applied to General Pediatric Policlinic and Pediatric Emergency Department of Ege University Medical Faculty in between March 2015-February 2016. Patients that were in term of newborn and have a disease caused fever (FMF, PFAPA etc.) were excluded. A case report form of existing from story and physical examination was filled by the doctor. Complete blood count, CRP, erythrocyte sedimentation rate and procalcitonin were performed all of patients. Urine analyse, direct examination of faeces, viral nasophryngeal swab, chest radiography, blood-urine-gaita–CSF culture samples were taken from patients with convenient clinic by being studied age of patient and situation of immunization. According to groups of age, ratio being encountered of viral/bacterical infection, effect of time being taken blood over acute phase reaction were evaluated as to be viral/bacterical being determined. ROC analyse was made for being evaluated activity of acute phase reaction according to infection was viral or bacterical. Results: %54.7 was male, %45.3 was female of the patients and their average of ages were 56.6 ± 48.0 months. Gender of male was determined more viral infections and gender of female was found more bacterical infections. As %38.3 viral tonsillopharyngitis, %16 pneumonia, %11 bacterical tonsillopharyngitis, %9 sinusitis, %8.7 urinary tract infection, %3.7 acute otitis media, %3.3 acute gastroenteritis ,%2 acute bronchiolitis, %1.7 occult bacteriemia and %6.3 others of the cases were classified. In existence of prodromal period of viral infection, was significant. When the body temperature increased, that possibility of bacterical infection increased was seen. General condition was not statistically significant in division of viral-bacterical infection alone. Leukopenia in viral infections and leukocytosis in bacterical infections were seen much more. Neutropenia in viral infections and neutrophilia in bacterical infections were found. When 15.000/mm3 cut-off was selected for number of leukocyte, sensitivity %33 and specificity %88 were determined. When CRP increased, that possibility of bacterical infection increased was seen. That CRP was a better marker was determined, when it was taken between 12-24 hours. Rising of erythrocyte sedimentation rate like CRP was found in bacterical's favour statistically, after 72nd hours, ıt was seen more valuable. Cut-off value with %61 sensitivity and %64 specificity was over 19 mm/h. Possibility to be bacterical of cases which have high procalcitonin was evaluated meaningfully. It was seen more valuable in measurements between 12-24 hours. Cut-off value with %62 sensitivity and %61 specificity was 0.19 mcg/L. Positive blood cultures was found %5.7. The microorganisms were Acinetobacter lwoffi, Streptococcus pneumonia, Coagulase negative staphilococcus and Pseudomonas aeruginosa. Positive urine cultures was %26.1. The most often microorganism was E.Coli (%47). Campylobacter coli reproduction was revealed in gaita culture of a case. CSF sample was taken from %1.6 case but all of them was negative. Transtracheal aspirate sample was taken from %1 cases and all of the transtracheal aspirate cultures was positive. Factors: As pseudomonas aeruginosa, streptococcus pneumonia, staphilococcus aureus+haemophilus influenza non type B were determined. Nasopharyngeal viral swab was taken from 25 cases in total. 4 (%16) from these were negative and 21 (%84) were positive. The most often virus was influenza. When we searched antibiotic using, in spite of viral infection, there were 50 (%51) cases that took antibiotic before applying. There were 92 (%65.7) cases that not took antibiotic before applying in ones with bacterical infection. 98 ones that took antibiotic among all of cases were detected. The most being used antibiotic was amoxicillin-clavulanate in %29 ratio. Conclusion: That fever which infectious caused in children associted with simple viral infection was repeated with this study. That body temperature and existence of prodromal term were important parameters in bacterical-viral infection division were demonstrated. It was stressed that laboratory tests were needed according to situation of immunization and age of patient, because general aspect in bacterical-viral infection division was not a guessworker alone. When sensitivity of leukocyte count was rather low, the best marker especially was CRP in case of measuring fever in 12-24 hours. Erythrocyte sedimentation rate was more valuable in cases of late term. İn spite of viral infection, ratio of using antibiotic was so high before applying. Clinic story: It was decided that treatment fees were decreased, bacterial infections were not misdiagnosed and viral infections were not treated with antibiotics as using effective laboratory parameters in diagnosis. İn this way we can prevent antibiotic resistance and side effects.