Neutrophil CD64 index (CD64in) is the best individual marker for bacterial sepsis in children, while in neonates the highest diagnostic accuracy at the time of suspected sepsis was achieved by LBP and 24 h later by CD64in.

Objective. To evaluate the expression of CD64 and CD163 on neutrophils and monocytes in SIRS with/without sepsis and to compare the diagnostic accuracy of CD64 and CD163 molecules expression determined as (1) mean fluorescence intensities (MFI) of CD64 and CD163; and (2) the ratio (index) of linearized MFI to the fluorescence signal of standardized beads. Patients and methods. Fifty-six critically ill neonates and children with systemic inflammatory response syndrome (SIRS) and suspected sepsis, classified into two groups: SIRS with sepsis (n = 29) and SIRS without sepsis (n = 27). Results. CD64 and CD163 MFI measured on neutrophils and monocytes were elevated in patients with SIRS with sepsis. Diagnostic accuracy of indexes was equal to diagnostic accuracy of MFI for CD64 on neutrophils (0.833 versus 0.854 for day 0 and 0.975 versus 0.983 for day 1) and monocytes (0.811 versus 0.865 for day 0 and 0.825 versus 0.858 for day 1), and CD163 on neutrophils (0.595 versus 0.655 for day 0 and 0.677 versus 0.750 for day 1), but not for CD163 on monocytes. Conclusion. CD64 MFI, CD163 MFI, CD64 indexes for neutrophils and monocytes, and CD163 index for neutrophils can all be used for discrimination of SIRS and sepsis in critically ill neonates and children. CD64 index for neutrophils, however, is superior to all other markers.

P lacement of external ventricular drainage (EVD) and draining of the cerebrospinal fluid (CSF) when intracranial pressure (ICP) is elevated are frequently used for treating intracranial hypertension caused by a variety of neurological conditions. However, such an invasive procedure allows free entrance for bacteria and presents an increased risk of infection that can lead to meningitis, ventriculitis, or even death. The incidence of EVD-related ventriculitis ranges from 10% to 27% according to the literature (1-5). The most significant group of microorganisms causing ventriculitis is Staphylococcus spp., especially coagulase-negative staphylococci, followed by Staphylococcus aureus. Other Grampositive organisms, such as Streptococcus spp., Enterococcus spp., Corynebacterium spp., and Propionibacterium spp., may be involved. Most ventricular infections are a result of contamination during the insertion of the EVD (6, 7). In order to prevent this complication or to detect initiating steps of the disease, early diagnosis and treatment are crucial, yet little has been reported in the literature about its management. The CSF total cell count, differential count, and concentration of proteins and glucose are parameters providing early information pertaining to the diagnosis of bacterial CSF infection. However, cell counts are often unreliable because of blood contamination of the CSF caused by primary or secondary ventricular hemorrhage or by chemical reactions to the drain material. Blood laboratory markers are also frequently elevated because of concomitant bacterial infection (8). C-reactive protein (CRP) and procalcitonin (PCT) were tested for their use to predict infection, but the results were contradictory (8, 9). Bacteriological culture methods such as CSF cultures may take several days until bacterial growth can safely be excluded (9). Furthermore, many patients with EVD are on antibiotic therapy and isolation of bacteria from CSF is often difficult. Thus, there is a need for new markers with higher specificity for early detection of meningitis and ventriculitis. Brain macrophages play a pivotal role during inflammatory reactions of the central nervous system (CNS) parenchyma, ventricles, and meninges, and are involved in the release of soluble CD14 (sCD14) (10). In a study of 91 patients, serum sCD14 levels were measured, and the levels increased during acute bacterial meningitis. Increased CSF and serum sCD14 concentrations were also observed in meningitis caused by viral infection. Repeated measurement of sCD14 in CSF revealed a normalization of sCD14 levels during clinical recovery (10). Determination of presepsin (sCD14-ST) in CSF could overcome problems with time-consuming procedures while measuring sCD14. CD14 is a glycosylphosphatidylinositol (GPI)-anchored glycoprotein

The physiological increase in PCT after birth and the impact of underlying disease make the interpretation of postoperative values in the immediate postnatal period difficult. IL-6 is a very sensitive marker of neonatal surgical injury with considerable variation between different types of surgery. IL-8 response after neonatal surgery is similar after all types of surgery, very rapid and transient with relatively low concentrations. CRP response to surgery is slow with persistence of elevated levels throughout the study period. IL-8 could potentially be a useful marker for monitoring infection in the immediate postoperative period in neonates.

The aim of the study was to evaluate the diagnostic accuracy of interleukin-6 (IL-6) and lipopolysaccharide-binding protein (LBP) in children with acute appendicitis (AA) and to compare this with the diagnostic accuracy of routinely used C-reactive protein (CRP) and white blood cell (WBC) count. Eighty-two consecutive children admitted to our Department because of suspected AA were enrolled in this prospective study and classified into two groups: group 1 (49 children who underwent surgery for AA) and group 2 (33 children with no surgery with diagnosis of non-specific abdominal pain or sonographic mesenteric lymphadenitis). There were no negative appendectomies during the time of the study. The patients were further classified into three subgroups: subgroup 1A (43 patients with advanced AA), subgroup 2A (11 patients with mesenteric lymphadenitis) and subgroup 2B (10 patients with non-specific abdominal pain). The perforation rate was 32.7 %. WBC count and serum CRP, IL-6 and LBP were measured on admission. Area under receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity and predictive values were evaluated. Serum IL-6 and LBP were significantly higher in group 1 than in group 2. The highest AUC for AA was that for IL-6 (0.776), followed by WBC count (0.684), CRP (0.637) and LBP (0.635). In conclusion, only IL-6, determined on admission, showed medium diagnostic accuracy, while other laboratory markers showed low diagnostic accuracy for AA in children. The new laboratory markers therefore do not significantly improve the diagnosis of AA.