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To the Editor Thank you for publishing the study of Milcent et al1 reporting the test characteristics of procalcitonin for the assessment of febrile infants. The authors should be congratulated on this large, observational study and their detailed analysis; in particular, I am pleased at their decision to analyze invasive bacterial infection (IBI) as distinct from serious bacterial infection. They are correct to separate out urinary tract infection, which can be diagnosed with a high degree of certainty using urinalysis/microscopy without needing additional markers.2 They have confirmed the low prevalence (pretest probability) of IBI—0.6% to 1.0% for bacteremia and 0.4% to 0.6% for meningitis (0.5%-0.8% and 0.2%-0.4%, respectively, if the infant is 31-91 days old)1—in febrile infants in areas with comprehensive immunization.3
Britton PN. Use of Procalcitonin Assays to Predict Serious Bacterial Infection in Young Febrile Infants. JAMA Pediatr. 2016;170(6):622-623. doi:10.1001/jamapediatrics.2016.0379