array:23 [
  "pii" => "S2341287916300278"
  "issn" => "23412879"
  "doi" => "10.1016/j.anpede.2016.03.001"
  "estado" => "S300"
  "fechaPublicacion" => "2016-05-01"
  "aid" => "2077"
  "copyright" => "Asociación Española de Pediatría"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "An Pediatr (Barc). 2016;84:247-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1857
    "formatos" => array:3 [
      "EPUB" => 129
      "HTML" => 1276
      "PDF" => 452
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1695403316301138"
      "issn" => "16954033"
      "doi" => "10.1016/j.anpedi.2016.03.007"
      "estado" => "S300"
      "fechaPublicacion" => "2016-05-01"
      "aid" => "2077"
      "copyright" => "Asociación Española de Pediatría"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "An Pediatr (Barc). 2016;84:247-8"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 5447
        "formatos" => array:3 [
          "EPUB" => 132
          "HTML" => 4158
          "PDF" => 1157
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "Biomarcadores de infecci&#243;n bacteriana grave&#58; &#191;ayudan en la pr&#225;ctica cl&#237;nica&#63;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "247"
            "paginaFinal" => "248"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Biomarkers of severe bacterial infection&#58; Do they help in clinical practice&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 928
                "Ancho" => 1547
                "Tamanyo" => 75790
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cin&#233;tica de los marcadores en caso de buena o mala evoluci&#243;n del paciente&#46; Las flechas indican los 4 valores evolutivos que m&#225;s informaci&#243;n proporcionan&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "C&#46; Rey Gal&#225;n"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Rey Gal&#225;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341287916300278"
          "doi" => "10.1016/j.anpede.2016.03.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916300278?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316301138?idApp=UINPBA00005H"
      "url" => "/16954033/0000008400000005/v1_201604260918/S1695403316301138/v1_201604260918/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2341287916000211"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2015.09.034"
    "estado" => "S300"
    "fechaPublicacion" => "2016-05-01"
    "aid" => "1963"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2016;84:249-53"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2810
      "formatos" => array:3 [
        "EPUB" => 143
        "HTML" => 2056
        "PDF" => 611
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Lung ultrasound as a tool to guide the administration of surfactant in premature neonates"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "249"
          "paginaFinal" => "253"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "La ecograf&#237;a pulmonar como herramienta para guiar la surfactaci&#243;n en neonatos prematuros"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1266
              "Ancho" => 1500
              "Tamanyo" => 259299
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest radiograph in a newborn with respiratory distress syndrome&#46; &#40;B&#41; Chest radiograph of the newborn at the time of discharge&#46; &#40;C&#41; Longitudinal lung ultrasound in the same patient&#44; showing a diffuse and compact pattern of lines&#46; The arrow points at the thickened and irregular pleura&#46; Once the patient was intubated&#44; lung sliding was observed bilaterally&#46; &#40;D&#41; Longitudinal lung ultrasound of the patient with a normal hyperechoic pleural line&#46; A lines are thin and parallel to one another&#44; with discernible rib shadows confirming normal appearance without B lines or comet tail artefacts&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Rodr&#237;guez-Fanjul, C&#46; Balcells Esponera, J&#46; Moreno Hernando, G&#46; Sarquella-Brugada"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Rodr&#237;guez-Fanjul"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Balcells Esponera"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Moreno Hernando"
            ]
            3 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Sarquella-Brugada"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403315003641"
        "doi" => "10.1016/j.anpedi.2015.09.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315003641?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916000211?idApp=UINPBA00005H"
    "url" => "/23412879/0000008400000005/v1_201604260918/S2341287916000211/v1_201604260918/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Biomarkers of severe bacterial infection&#58; Do they help in clinical practice&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "247"
        "paginaFinal" => "248"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "C&#46; Rey Gal&#225;n"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Rey Gal&#225;n"
            "email" => array:2 [
              0 => "crey&#64;uniovi&#46;es"
              1 => "corsino&#46;rey&#64;sespa&#46;princast&#46;es"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Unidad de Cuidados Intensivos Pedi&#225;tricos&#44; &#193;rea de Gesti&#243;n Cl&#237;nica de Pediatr&#237;a&#44; Hospital Universitario Central de Asturias&#44; Universidad de Oviedo&#44; Oviedo&#44; Asturias&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Biomarcadores de infecci&#243;n bacteriana grave&#58; &#191;ayudan en la pr&#225;ctica cl&#237;nica&#63;"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 928
            "Ancho" => 1547
            "Tamanyo" => 72356
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kinetics of markers in the event of patient improvement and of disease progression&#46; The arrows indicate the 4 clinical course markers that provide the most information&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Biomarkers capable of providing rapid diagnosis of severe bacterial infections &#40;SBIs&#41;&#44; establishing their prognosis&#44; monitoring their course and helping to decide the earliest moment to withdraw antibiotics without the risk of a relapse would be a great help in clinical practice&#46; Nearly 200 molecules have been proposed as potential markers&#44; though only 20&#37; have reached the point of being evaluated in appropriate studies&#46; The latest research focuses on the fields of genomics and metabolomics&#44; and the application of solutions based on nanotechnology to prevent&#44; detect and treat SBIs has begun to be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> While we await the results of these studies&#44; we need to optimise the use of the markers most commonly employed in clinical practice&#58; C-reactive protein &#40;CRP&#41;&#44; procalcitonin &#40;PCT&#41; and interleukin 6 &#40;IL-6&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Studies such as the one published in this issue of <span class="elsevierStyleItalic">Anales de Pediatr&#237;a</span> by Parada et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> evaluating the impact of PCT on the management of hospitalised febrile infants&#44; are greatly needed&#46; As the authors point out&#44; the retrospective nature of the study&#44; the small number of patients with SBIs&#44; 75&#37; of them with urinary infections&#44; and the administration of antibiotics to patients without SBIs weaken the conclusions&#46; Nevertheless&#44; their findings alert us to the importance of analysing the value &#40;or lack of value&#41; that markers add to clinical practice&#46; In contrast&#44; in a recent multicentre study on 2047 febrile infants Milcent et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> found that PCT &#40;cut-off value&#58; 0&#46;3<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#59; area under curve&#58; 0&#46;91&#59; 95&#37; CI&#58; 0&#46;83&#8211;0&#46;99&#41; was superior to CRP &#40;cut-off value&#58; 2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; area under curve&#58; 0&#46;75&#59; 95&#37; CI&#58; 0&#46;65&#8211;0&#46;89&#41; for detecting invasive bacterial infection and that the two markers were similar for detecting SBI&#46; Their results suggest that these markers could enhance clinical practice in febrile infants&#46; We will try to analyse the limitations and strengths of markers so as to understand the contradictory results of many published studies and attempt to get the most out of them&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Early diagnosis and treatment of SBIs influence their prognosis&#46; The first limitation of CRP&#44; PCT and IL-6 is that their levels rise in the presence of any inflammatory response&#44; both when the cause is infection and when it is trauma&#44; severe shock or a situation involving tissue necrosis &#40;postoperative complications&#44; major burns&#44; etc&#46;&#41;&#46; Therefore when we have an elevated result&#44; we have to decide whether there is some non-infectious cause to explain that rise or whether&#44; on the contrary&#44; we should begin antibiotic treatment immediately&#46; If the result is low&#44; it is unlikely that there is an SBI&#44; although it is vital to take the kinetics of these markers into account to avoid asking for them at times when a low level is of no value&#44; either because it is too soon for them to have started rising or because it is too late for them to have remained elevated&#46; IL-6 rises in the first 2&#8211;3<span class="elsevierStyleHsp" style=""></span>h after the insult&#44; PCT between 6 and 12<span class="elsevierStyleHsp" style=""></span>h and CRP between 24 and 48<span class="elsevierStyleHsp" style=""></span>h&#46; Therefore&#44; to perform an early diagnosis and decide on an immediate antibiotic treatment the ideal marker would be IL-6&#44; followed by PCT&#46; IL-6 sometimes falls very rapidly and could therefore give us a false negative if the request is late&#44; and CRP is more useful if at least 24<span class="elsevierStyleHsp" style=""></span>h have elapsed since the onset of symptoms&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The cut-off values are set depending on how sensitive and specific we wish the test to be&#46; We must treat our patients individually and use the marker as one more aid in the decision&#44; establishing whether we want to prioritise sensitivity&#44; as in the case of immunodepressed patients&#44; in whom we prefer to start antibiotics rather than running the risk of delayed treatment&#46; The normal value for PCT in the healthy population&#44; discounting the presence of inflammation&#44; is less than 0&#46;1<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#46; However&#44; in the published studies cut-off values of between 0&#46;2 and 0&#46;5<span class="elsevierStyleHsp" style=""></span>ng&#47;mL are established for SBI in previously healthy patients&#44; 1&#8211;2<span class="elsevierStyleHsp" style=""></span>ng&#47;mL for SBI in intensive care patients and 2&#8211;5<span class="elsevierStyleHsp" style=""></span>ng&#47;mL for postoperative patients&#46; The same is true for the other inflammatory markers&#46; The cut-off values also vary depending on the information we want to obtain from the marker&#44; with different values for trying to predict the risk of mortality or for indicating withdrawal of antibiotics&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In hospitalised patients it is the kinetics of successive values&#44; rather than one isolated value&#44; that have most to contribute&#46; Generally there are 4 useful values &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#58; &#40;1&#41; initial value of the marker &#40;this will be the one that helps to confirm or rule out the diagnostic suspicion&#41;&#44; &#40;2&#41; maximum value &#40;marks the worst point in the course of the disease&#41;&#44; &#40;3&#41; falling value &#40;confirms good response to treatment&#41;&#44; &#40;4&#41; value below which we consider withdrawing the antibiotics &#40;end of the process&#41;&#46; PCT has been the most studied for monitoring this course&#44; since its kinetic is suitable&#46; It begins to rise quite rapidly &#40;6&#8211;12<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; reaches its maximum value in 24&#8211;48<span class="elsevierStyleHsp" style=""></span>h&#44; and if progress is favourable it begins to fall from that point&#44; halving its previous value every 24<span class="elsevierStyleHsp" style=""></span>h&#46; CRP is also useful&#44; although its slower kinetics cause it to rise and fall about 24<span class="elsevierStyleHsp" style=""></span>h later&#46; IL-6 tends to fall very rapidly and is therefore not useful for monitoring the course of the infection&#44; nor as a criterion for withdrawal of antibiotic treatment&#46; If the disease progresses unfavourably&#44; the marker levels do not fall but remain raised for a period of time &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; indicating a possible need for a change of therapy&#44; specifically in antibiotic treatment&#44; while awaiting blood cultures&#44; in the case of infection&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In the last few years a number of studies have been published in which markers are used as a guide for withdrawal of antibiotic treatment&#46; PCT has been the object of several trials and meta-analyses&#46; The levels proposed for suspending antibiotics are below 0&#46;25<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#44; or between 0&#46;25 and 0&#46;50<span class="elsevierStyleHsp" style=""></span>ng&#47;mL provided they are below 80&#37; of the maximum value reached&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> CRP may also be suitable for this purpose&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Other markers that may provide information for decisions on the prognosis and admission of patients are being investigated&#46; The use of panels of biomarkers has been described as a solution that benefits from the advantages and reduces the limitations of an isolated marker&#46; However&#44; greater methodological rigour is needed in clinical studies with markers to demonstrate the cost-effectiveness of such combinations&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To sum up&#44; Parada et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> have highlighted the need to assess the impact of introducing biomarkers into clinical practice&#46; Issues such as proper training of medical staff before instituting a diagnostic test&#44; appropriate selection of the patients for whom the request is to be made&#44; interpretation of the results in the clinical context of each patient and making people aware that all tests have a cost must be kept firmly in mind&#46; We should not routinely request a marker without having considered beforehand&#44; after an exhaustive clinical assessment&#44; what approach we will adopt according to the result we receive&#46; Requesting a large number of laboratory tests is not synonymous with better clinical practice&#44; but rather the opposite&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">Corsino Rey has received funding from the Brahms and Thermofisher companies to give lectures at conferences on subjects related to biomarkers and sepsis&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Rey Gal&#225;n C&#46; Biomarcadores de infecci&#243;n bacteriana grave&#58; &#191;ayudan en la pr&#225;ctica cl&#237;nica&#63;&#46; An Pediatr &#40;Barc&#41;&#46; 2016&#59;84&#58;247&#8211;248&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 928
            "Ancho" => 1547
            "Tamanyo" => 72356
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kinetics of markers in the event of patient improvement and of disease progression&#46; The arrows indicate the 4 clinical course markers that provide the most information&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New approaches to sepsis&#58; molecular diagnostics and biomarkers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Reinhart"
                            1 => "M&#46; Bauer"
                            2 => "N&#46;C&#46; Riedemann"
                            3 => "C&#46;S&#46; Hartog"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CMR.00016-12"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Rev"
                        "fecha" => "2012"
                        "volumen" => "25"
                        "paginaInicial" => "609"
                        "paginaFinal" => "634"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23034322"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Valoraci&#243;n del uso de la procalcitonina en el lactante febril hospitalizado"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Parada"
                            1 => "O&#46; Calavia"
                            2 => "M&#46; Dur&#225;n-Ball&#233;n"
                            3 => "A&#46; V&#225;squez"
                            4 => "R&#46; Ayats"
                            5 => "N&#46; Ferr&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
                        "fecha" => "2016"
                        "volumen" => "84"
                        "paginaInicial" => "278"
                        "paginaFinal" => "285"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of procalcitonin assays to predict serious bacterial infection in young febrile infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Milcent"
                            1 => "S&#46; Faesch"
                            2 => "C&#46; Gras-Le Guen"
                            3 => "F&#46; Dubos"
                            4 => "C&#46; Poulalhon"
                            5 => "I&#46; Badier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamapediatrics.2015.3210"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Pediatr"
                        "fecha" => "2016"
                        "volumen" => "170"
                        "paginaInicial" => "62"
                        "paginaFinal" => "69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26595253"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic markers for pediatric septic shock&#58; which ones&#44; when&#44; and how&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Rey"
                            1 => "J&#46;D&#46; Fortenberry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-013-3027-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "1851"
                        "paginaFinal" => "1853"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23900580"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents &#40;ProPAED&#41;&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Baer"
                            1 => "P&#46; Baumann"
                            2 => "M&#46; Buettcher"
                            3 => "U&#46; Heininger"
                            4 => "G&#46; Berthet"
                            5 => "J&#46; Sch&#228;fer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0068419"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "e68419"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23936304"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23412879/0000008400000005/v1_201604260918/S2341287916300278/v1_201604260918/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "25501"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008400000005/v1_201604260918/S2341287916300278/v1_201604260918/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916300278?idApp=UINPBA00005H"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Editorial
Biomarkers of severe bacterial infection: Do they help in clinical practice?
Biomarcadores de infección bacteriana grave: ¿ayudan en la práctica clínica?
C. Rey Galán
Unidad de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
Read
6059
Times
was read the article
2141
Total PDF
3918
Total HTML
Share statistics
 array:23 [
  "pii" => "S2341287916300278"
  "issn" => "23412879"
  "doi" => "10.1016/j.anpede.2016.03.001"
  "estado" => "S300"
  "fechaPublicacion" => "2016-05-01"
  "aid" => "2077"
  "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "An Pediatr &#40;Barc&#41;. 2016;84:247-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1857
    "formatos" => array:3 [
      "EPUB" => 129
      "HTML" => 1276
      "PDF" => 452
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1695403316301138"
      "issn" => "16954033"
      "doi" => "10.1016/j.anpedi.2016.03.007"
      "estado" => "S300"
      "fechaPublicacion" => "2016-05-01"
      "aid" => "2077"
      "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "An Pediatr &#40;Barc&#41;. 2016;84:247-8"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 5447
        "formatos" => array:3 [
          "EPUB" => 132
          "HTML" => 4158
          "PDF" => 1157
        ]
      ]
      "es" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "Biomarcadores de infecci&#243;n bacteriana grave&#58; &#191;ayudan en la pr&#225;ctica cl&#237;nica&#63;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "247"
            "paginaFinal" => "248"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Biomarkers of severe bacterial infection&#58; Do they help in clinical practice&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 928
                "Ancho" => 1547
                "Tamanyo" => 75790
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cin&#233;tica de los marcadores en caso de buena o mala evoluci&#243;n del paciente&#46; Las flechas indican los 4 valores evolutivos que m&#225;s informaci&#243;n proporcionan&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "C&#46; Rey Gal&#225;n"
            "autores" => array:1 [
              0 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Rey Gal&#225;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341287916300278"
          "doi" => "10.1016/j.anpede.2016.03.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916300278?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403316301138?idApp=UINPBA00005H"
      "url" => "/16954033/0000008400000005/v1_201604260918/S1695403316301138/v1_201604260918/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2341287916000211"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2015.09.034"
    "estado" => "S300"
    "fechaPublicacion" => "2016-05-01"
    "aid" => "1963"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2016;84:249-53"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2810
      "formatos" => array:3 [
        "EPUB" => 143
        "HTML" => 2056
        "PDF" => 611
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Lung ultrasound as a tool to guide the administration of surfactant in premature neonates"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "249"
          "paginaFinal" => "253"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "La ecograf&#237;a pulmonar como herramienta para guiar la surfactaci&#243;n en neonatos prematuros"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1266
              "Ancho" => 1500
              "Tamanyo" => 259299
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Chest radiograph in a newborn with respiratory distress syndrome&#46; &#40;B&#41; Chest radiograph of the newborn at the time of discharge&#46; &#40;C&#41; Longitudinal lung ultrasound in the same patient&#44; showing a diffuse and compact pattern of lines&#46; The arrow points at the thickened and irregular pleura&#46; Once the patient was intubated&#44; lung sliding was observed bilaterally&#46; &#40;D&#41; Longitudinal lung ultrasound of the patient with a normal hyperechoic pleural line&#46; A lines are thin and parallel to one another&#44; with discernible rib shadows confirming normal appearance without B lines or comet tail artefacts&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Rodr&#237;guez-Fanjul, C&#46; Balcells Esponera, J&#46; Moreno Hernando, G&#46; Sarquella-Brugada"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Rodr&#237;guez-Fanjul"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Balcells Esponera"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Moreno Hernando"
            ]
            3 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Sarquella-Brugada"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403315003641"
        "doi" => "10.1016/j.anpedi.2015.09.003"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315003641?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916000211?idApp=UINPBA00005H"
    "url" => "/23412879/0000008400000005/v1_201604260918/S2341287916000211/v1_201604260918/en/main.assets"
  ]
  "en" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Biomarkers of severe bacterial infection&#58; Do they help in clinical practice&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "247"
        "paginaFinal" => "248"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "C&#46; Rey Gal&#225;n"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Rey Gal&#225;n"
            "email" => array:2 [
              0 => "crey&#64;uniovi&#46;es"
              1 => "corsino&#46;rey&#64;sespa&#46;princast&#46;es"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Unidad de Cuidados Intensivos Pedi&#225;tricos&#44; &#193;rea de Gesti&#243;n Cl&#237;nica de Pediatr&#237;a&#44; Hospital Universitario Central de Asturias&#44; Universidad de Oviedo&#44; Oviedo&#44; Asturias&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Biomarcadores de infecci&#243;n bacteriana grave&#58; &#191;ayudan en la pr&#225;ctica cl&#237;nica&#63;"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 928
            "Ancho" => 1547
            "Tamanyo" => 72356
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kinetics of markers in the event of patient improvement and of disease progression&#46; The arrows indicate the 4 clinical course markers that provide the most information&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Biomarkers capable of providing rapid diagnosis of severe bacterial infections &#40;SBIs&#41;&#44; establishing their prognosis&#44; monitoring their course and helping to decide the earliest moment to withdraw antibiotics without the risk of a relapse would be a great help in clinical practice&#46; Nearly 200 molecules have been proposed as potential markers&#44; though only 20&#37; have reached the point of being evaluated in appropriate studies&#46; The latest research focuses on the fields of genomics and metabolomics&#44; and the application of solutions based on nanotechnology to prevent&#44; detect and treat SBIs has begun to be considered&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> While we await the results of these studies&#44; we need to optimise the use of the markers most commonly employed in clinical practice&#58; C-reactive protein &#40;CRP&#41;&#44; procalcitonin &#40;PCT&#41; and interleukin 6 &#40;IL-6&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Studies such as the one published in this issue of <span class="elsevierStyleItalic">Anales de Pediatr&#237;a</span> by Parada et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> evaluating the impact of PCT on the management of hospitalised febrile infants&#44; are greatly needed&#46; As the authors point out&#44; the retrospective nature of the study&#44; the small number of patients with SBIs&#44; 75&#37; of them with urinary infections&#44; and the administration of antibiotics to patients without SBIs weaken the conclusions&#46; Nevertheless&#44; their findings alert us to the importance of analysing the value &#40;or lack of value&#41; that markers add to clinical practice&#46; In contrast&#44; in a recent multicentre study on 2047 febrile infants Milcent et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> found that PCT &#40;cut-off value&#58; 0&#46;3<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#59; area under curve&#58; 0&#46;91&#59; 95&#37; CI&#58; 0&#46;83&#8211;0&#46;99&#41; was superior to CRP &#40;cut-off value&#58; 2<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#59; area under curve&#58; 0&#46;75&#59; 95&#37; CI&#58; 0&#46;65&#8211;0&#46;89&#41; for detecting invasive bacterial infection and that the two markers were similar for detecting SBI&#46; Their results suggest that these markers could enhance clinical practice in febrile infants&#46; We will try to analyse the limitations and strengths of markers so as to understand the contradictory results of many published studies and attempt to get the most out of them&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Early diagnosis and treatment of SBIs influence their prognosis&#46; The first limitation of CRP&#44; PCT and IL-6 is that their levels rise in the presence of any inflammatory response&#44; both when the cause is infection and when it is trauma&#44; severe shock or a situation involving tissue necrosis &#40;postoperative complications&#44; major burns&#44; etc&#46;&#41;&#46; Therefore when we have an elevated result&#44; we have to decide whether there is some non-infectious cause to explain that rise or whether&#44; on the contrary&#44; we should begin antibiotic treatment immediately&#46; If the result is low&#44; it is unlikely that there is an SBI&#44; although it is vital to take the kinetics of these markers into account to avoid asking for them at times when a low level is of no value&#44; either because it is too soon for them to have started rising or because it is too late for them to have remained elevated&#46; IL-6 rises in the first 2&#8211;3<span class="elsevierStyleHsp" style=""></span>h after the insult&#44; PCT between 6 and 12<span class="elsevierStyleHsp" style=""></span>h and CRP between 24 and 48<span class="elsevierStyleHsp" style=""></span>h&#46; Therefore&#44; to perform an early diagnosis and decide on an immediate antibiotic treatment the ideal marker would be IL-6&#44; followed by PCT&#46; IL-6 sometimes falls very rapidly and could therefore give us a false negative if the request is late&#44; and CRP is more useful if at least 24<span class="elsevierStyleHsp" style=""></span>h have elapsed since the onset of symptoms&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The cut-off values are set depending on how sensitive and specific we wish the test to be&#46; We must treat our patients individually and use the marker as one more aid in the decision&#44; establishing whether we want to prioritise sensitivity&#44; as in the case of immunodepressed patients&#44; in whom we prefer to start antibiotics rather than running the risk of delayed treatment&#46; The normal value for PCT in the healthy population&#44; discounting the presence of inflammation&#44; is less than 0&#46;1<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#46; However&#44; in the published studies cut-off values of between 0&#46;2 and 0&#46;5<span class="elsevierStyleHsp" style=""></span>ng&#47;mL are established for SBI in previously healthy patients&#44; 1&#8211;2<span class="elsevierStyleHsp" style=""></span>ng&#47;mL for SBI in intensive care patients and 2&#8211;5<span class="elsevierStyleHsp" style=""></span>ng&#47;mL for postoperative patients&#46; The same is true for the other inflammatory markers&#46; The cut-off values also vary depending on the information we want to obtain from the marker&#44; with different values for trying to predict the risk of mortality or for indicating withdrawal of antibiotics&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In hospitalised patients it is the kinetics of successive values&#44; rather than one isolated value&#44; that have most to contribute&#46; Generally there are 4 useful values &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#58; &#40;1&#41; initial value of the marker &#40;this will be the one that helps to confirm or rule out the diagnostic suspicion&#41;&#44; &#40;2&#41; maximum value &#40;marks the worst point in the course of the disease&#41;&#44; &#40;3&#41; falling value &#40;confirms good response to treatment&#41;&#44; &#40;4&#41; value below which we consider withdrawing the antibiotics &#40;end of the process&#41;&#46; PCT has been the most studied for monitoring this course&#44; since its kinetic is suitable&#46; It begins to rise quite rapidly &#40;6&#8211;12<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; reaches its maximum value in 24&#8211;48<span class="elsevierStyleHsp" style=""></span>h&#44; and if progress is favourable it begins to fall from that point&#44; halving its previous value every 24<span class="elsevierStyleHsp" style=""></span>h&#46; CRP is also useful&#44; although its slower kinetics cause it to rise and fall about 24<span class="elsevierStyleHsp" style=""></span>h later&#46; IL-6 tends to fall very rapidly and is therefore not useful for monitoring the course of the infection&#44; nor as a criterion for withdrawal of antibiotic treatment&#46; If the disease progresses unfavourably&#44; the marker levels do not fall but remain raised for a period of time &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; indicating a possible need for a change of therapy&#44; specifically in antibiotic treatment&#44; while awaiting blood cultures&#44; in the case of infection&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In the last few years a number of studies have been published in which markers are used as a guide for withdrawal of antibiotic treatment&#46; PCT has been the object of several trials and meta-analyses&#46; The levels proposed for suspending antibiotics are below 0&#46;25<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#44; or between 0&#46;25 and 0&#46;50<span class="elsevierStyleHsp" style=""></span>ng&#47;mL provided they are below 80&#37; of the maximum value reached&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> CRP may also be suitable for this purpose&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Other markers that may provide information for decisions on the prognosis and admission of patients are being investigated&#46; The use of panels of biomarkers has been described as a solution that benefits from the advantages and reduces the limitations of an isolated marker&#46; However&#44; greater methodological rigour is needed in clinical studies with markers to demonstrate the cost-effectiveness of such combinations&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To sum up&#44; Parada et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> have highlighted the need to assess the impact of introducing biomarkers into clinical practice&#46; Issues such as proper training of medical staff before instituting a diagnostic test&#44; appropriate selection of the patients for whom the request is to be made&#44; interpretation of the results in the clinical context of each patient and making people aware that all tests have a cost must be kept firmly in mind&#46; We should not routinely request a marker without having considered beforehand&#44; after an exhaustive clinical assessment&#44; what approach we will adopt according to the result we receive&#46; Requesting a large number of laboratory tests is not synonymous with better clinical practice&#44; but rather the opposite&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">Corsino Rey has received funding from the Brahms and Thermofisher companies to give lectures at conferences on subjects related to biomarkers and sepsis&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflicts of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Rey Gal&#225;n C&#46; Biomarcadores de infecci&#243;n bacteriana grave&#58; &#191;ayudan en la pr&#225;ctica cl&#237;nica&#63;&#46; An Pediatr &#40;Barc&#41;&#46; 2016&#59;84&#58;247&#8211;248&#46;</p>"
      ]
    ]
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 928
            "Ancho" => 1547
            "Tamanyo" => 72356
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kinetics of markers in the event of patient improvement and of disease progression&#46; The arrows indicate the 4 clinical course markers that provide the most information&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "New approaches to sepsis&#58; molecular diagnostics and biomarkers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Reinhart"
                            1 => "M&#46; Bauer"
                            2 => "N&#46;C&#46; Riedemann"
                            3 => "C&#46;S&#46; Hartog"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1128/CMR.00016-12"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Microbiol Rev"
                        "fecha" => "2012"
                        "volumen" => "25"
                        "paginaInicial" => "609"
                        "paginaFinal" => "634"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23034322"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Valoraci&#243;n del uso de la procalcitonina en el lactante febril hospitalizado"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Parada"
                            1 => "O&#46; Calavia"
                            2 => "M&#46; Dur&#225;n-Ball&#233;n"
                            3 => "A&#46; V&#225;squez"
                            4 => "R&#46; Ayats"
                            5 => "N&#46; Ferr&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;"
                        "fecha" => "2016"
                        "volumen" => "84"
                        "paginaInicial" => "278"
                        "paginaFinal" => "285"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of procalcitonin assays to predict serious bacterial infection in young febrile infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Milcent"
                            1 => "S&#46; Faesch"
                            2 => "C&#46; Gras-Le Guen"
                            3 => "F&#46; Dubos"
                            4 => "C&#46; Poulalhon"
                            5 => "I&#46; Badier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamapediatrics.2015.3210"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Pediatr"
                        "fecha" => "2016"
                        "volumen" => "170"
                        "paginaInicial" => "62"
                        "paginaFinal" => "69"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26595253"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic markers for pediatric septic shock&#58; which ones&#44; when&#44; and how&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Rey"
                            1 => "J&#46;D&#46; Fortenberry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-013-3027-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "1851"
                        "paginaFinal" => "1853"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23900580"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents &#40;ProPAED&#41;&#58; a randomized controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Baer"
                            1 => "P&#46; Baumann"
                            2 => "M&#46; Buettcher"
                            3 => "U&#46; Heininger"
                            4 => "G&#46; Berthet"
                            5 => "J&#46; Sch&#228;fer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0068419"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS One"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "e68419"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23936304"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23412879/0000008400000005/v1_201604260918/S2341287916300278/v1_201604260918/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "25501"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008400000005/v1_201604260918/S2341287916300278/v1_201604260918/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287916300278?idApp=UINPBA00005H"
]
Article information
ISSN: 23412879
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 7 8 15
2024 October 54 34 88
2024 September 49 31 80
2024 August 86 50 136
2024 July 83 32 115
2024 June 81 31 112
2024 May 73 31 104
2024 April 67 35 102
2024 March 46 27 73
2024 February 65 31 96
2024 January 39 23 62
2023 December 46 14 60
2023 November 49 26 75
2023 October 50 26 76
2023 September 41 23 64
2023 August 35 20 55
2023 July 27 34 61
2023 June 34 36 70
2023 May 49 22 71
2023 April 37 20 57
2023 March 50 25 75
2023 February 29 24 53
2023 January 23 15 38
2022 December 59 27 86
2022 November 54 30 84
2022 October 50 39 89
2022 September 33 26 59
2022 August 54 48 102
2022 July 46 36 82
2022 June 41 24 65
2022 May 43 39 82
2022 April 38 46 84
2022 March 67 48 115
2022 February 38 26 64
2022 January 70 30 100
2021 December 47 42 89
2021 November 40 43 83
2021 October 64 59 123
2021 September 35 38 73
2021 August 42 45 87
2021 July 33 35 68
2021 June 37 42 79
2021 May 61 44 105
2021 April 136 77 213
2021 March 59 26 85
2021 February 25 10 35
2021 January 38 17 55
2020 December 12 15 27
2020 November 26 13 39
2020 October 30 15 45
2020 September 25 23 48
2020 August 19 9 28
2020 July 17 20 37
2020 June 41 8 49
2020 May 41 18 59
2020 April 37 21 58
2020 March 46 22 68
2020 February 38 14 52
2020 January 31 13 44
2019 December 43 19 62
2019 November 21 6 27
2019 October 39 13 52
2019 September 27 14 41
2019 August 121 34 155
2019 July 30 17 47
2019 June 28 28 56
2019 May 69 22 91
2019 April 57 9 66
2019 March 34 18 52
2019 February 42 15 57
2019 January 36 15 51
2018 December 29 22 51
2018 November 35 26 61
2018 October 43 16 59
2018 September 22 18 40
2018 August 2 0 2
2018 July 1 0 1
2018 June 3 0 3
2018 May 5 0 5
2018 April 26 0 26
2018 March 29 0 29
2018 February 37 0 37
2018 January 23 0 23
2017 December 32 0 32
2017 November 20 0 20
2017 October 19 0 19
2017 September 13 0 13
2017 August 15 0 15
2017 July 16 0 16
2017 June 30 13 43
2017 May 38 17 55
2017 April 34 25 59
2017 March 12 8 20
2017 February 16 8 24
2017 January 3 5 8
2016 December 22 13 35
2016 November 27 17 44
2016 October 34 19 53
2016 September 33 3 36
2016 August 38 4 42
2016 July 17 4 21
2016 June 0 7 7
2016 May 4 0 4
Show all

Follow this link to access the full text of the article

Idiomas
Anales de Pediatría (English Edition)
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?