Serial biomarker kinetics following microbiology-guided antibiotic therapy in pediatric sepsis: a retrospective cohort study
Year: 2026
Type: conference-paper
Study design: Observational Study
Abstract: Introduction Timely assessment of treatment response in pediatric sepsis remains a major clinical challenge and may delay optimization of antimicrobial therapy. Dynamic monitoring of inflammatory biomarkers could provide earlier insight into therapeutic effectiveness compared to static measurements. Aim To evaluate whether serial kinetics of C-reactive protein (CRP), procalcitonin (PCT), and presepsin can discriminate treatment response following microbiology-guided antibiotic adjustment in pediatric sepsis. Methods A retrospective cohort study was conducted in a surgical ICU over one year. Fifty-nine pediatric sepsis patients were included: 12 neonates, 20 <2 years, and 27 >2 years. CRP, PCT and presepsin were measured at baseline, 24, 48 and 72 hours. Antibiotic therapy was adjusted according to antibiogram when applicable. Biomarker kinetics were analyzed by age group and antibiotic modification status. Statistical analysis included repeated- measures comparison across time points. Results Antibiotic therapy was modified in 38 patients (64.4%). Patients with microbiology-guided adjustment showed significantly greater declines in procalcitonin (PCT) and presepsin over 72 hours compared with non-modified cases (p<0.05), while C-reactive protein (CRP) showed a consistent but non-significant downward trend. PCT decreased from 12.6 to 2.8 ng/mL in <2 years, from 3.51 to 0.41 in >2 years, and from 2.5 to 0.5 in neonates. Presepsin decreased from 800 to <300 pg/mL (<2 years), from 1000 to <400 (>2 years), and from 1050 to <100 in neonates. CRP decreased in parallel with clinical improvement but without significant intergroup differences. Discussion Early dynamic changes in PCT and presepsin appear to be more sensitive indicators of treatment response than CRP in pediatric sepsis. Serial inflammatory biomarkers may support assessment of treatment response in pediatric sepsis. PCT and presepsin showed stronger and statistically significant kinetic responses compared with CRP, indicating higher sensitivity to microbiology-guided antibiotic adjustment. These findings suggest that reliance on static biomarkers such as CRP may be insufficient in early treatment evaluation. CRP showed slower kinetics and limited short-term discriminatory value. Microbiology-guided antibiotic adjustment was associated with more favorable biomarker dynamics, although retrospective design and sample size restrict causal inference. Prospective studies are needed to validate these observations.
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225403181