Serum Procalcitonin and Discrimination of Bacterial from Viral Infections in Emergency Paediatric Admissions in Enugu

The accurate distinction of bacterial from viral infections in paediatric emergency settings is critical for appropriate antibiotic prescribing and antimicrobial stewardship. This study evaluates the diagnostic performance of serum procalcitonin in discriminating bacterial from viral infections in paediatric emergency admissions at a teaching hospital in Enugu, South East Nigeria. A prospective observational design was adopted, enrolling 150 children aged 1 month to 12 years admitted through the emergency unit with fever or systemic signs of infection. Procalcitonin, C-reactive protein, and white blood cell count with differential were measured at admission. Definitive infection classification was established by blood culture, urinalysis, chest radiography, cerebrospinal fluid analysis where clinically indicated, and clinician assessment at discharge. Receiver operating characteristic curve analysis was performed to determine the optimal procalcitonin cut-off for bacterial infection identification. The incremental diagnostic value of procalcitonin over CRP and white blood cell count was quantified. Findings will support the evidence base for procalcitonin-guided antibiotic decision-making in paediatric emergency medicine in South East Nigeria. Keywords: procalcitonin, bacterial infection, antimicrobial stewardship, paediatric emergency, Enugu.