Introduction: Pediatric patients with tracheostomy tubes are at increased risk for tracheal bacterial colonization, which can progress to tracheal infections such as tracheobronchitis. Serum procalcitonin (PCT) and C-reactive protein (CRP) are inflammatory markers commonly used to guide treatment when bacterial infection is suspected. However, their specific role in managing tracheobronchitis remains unclear. This study aims to investigate the correlation between PCT and CRP levels in cases of acute tracheobronchitis and to evaluate their utility in guiding treatment decisions, including the duration and choice of antibiotics.
Methods: This retrospective study that was carried out at a single-center, mixed medical-surgical Pediatric Intensive Care Unit (PICU). The study focused on patients aged 0-21 years who were admitted to the PICU between January 1, 2021, and June 30, 2023, and who developed tracheobronchitis. To identify relevant patients, we used ICD-10-CM codes for tracheostomy dependence and tracheobronchitis related diagnoses. Inclusion criteria were based on medical records that met the CDC definition for tracheobronchitis and included biomarkers of CRP and PCT collected at the onset of symptoms. Records were excluded if they lacked CRP or PCT data at symptom onset, if the patient had concurrent bacterial infections, or if the patient was receiving antibiotics at the time of the diagnosis. Patient's that had concurrent respiratory viral illnesses diagnosed via respiratory viral panel were analyzed in parallel to the patients who developed tracheobronchitis without co existing viral illness.
Results: Total of 41 patients (mean age 5.74 years) were studied, 23 that had no co-diagnosed virus and 18 who also had a virus diagnosed on respiratory viral panel. The median CRP was elevated in both (3.22 mg/dL and 3.62 mg/dL, P < 0.023) in group with viral co-infection. The PCT (cut off for normal PCT being < 0.5 ng/mL) patients with 0.0 ng/mL and 0.25 ng/mL in non-viral and viral group, respectively.
Conclusions: When evaluating tracheobronchitis, CRP and PCT values do not seem to correlate with the development of the illness, as both markers often remain with normal to low range. This lack of elevation complicates the diagnosis and delays the initiation of appropriate antibiotic therapy.
