Performance of procalcitonin point-of-care tests in predicting bacterial causes of acute febrile illness in Northwest Ethiopia
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Date
2025
Authors
Abebaw, D.
Lemma, M.
Akelew, Y.
Negash, M.
Alem, M.
Boodman, C.
Van Griensven, J.
Pareyn, M.
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BMC Infectious Diseases, 2025; 25(1, article no. 1593):1-9
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Objective Antimicrobial resistance in sub-Saharan Africa is fueled by empiric antibiotic use due to the absence of diagnostic testing for bacterial infections. We aimed to assess the performance of qualitative, semiquantitative, and quantitative procalcitonin (PCT) rapid point-of-care (POCT) tests in identifying bacterial causes of fever among acute febrile patients. Methods A total of 181 frozen serum samples from adults (aged over 15 years) were assessed via qualitative, semiquantitative, and quantitative procalcitonin tests. The agreement between the test methods was evaluated via kappa statistics. A composite reference test was created by combining the results from all the PCT methods, due to the absence of a reliable gold standard to verify bacterial infections and the unavailability of standard PCT references. Each test's diagnostic accuracy was compared with that of the reference test. Bacterial infections were determined on the basis of blood culture and qPCR for Borrelia and Rickettsia species. Results All the PCT tests had substantial to near-perfect agreement with each other (kappa = 0.69-0.81) and compared with the composite reference standard (kappa = 0.68-0.97). All three PCT test methods demonstrated excellent diagnostic accuracy, with an AUC ranging from 0.91 to 0.99; (95% CI 0.86-0.98 p < 0.001), in predicting bacterial infections, although the sensitivity and agreement decreased significantly at higher PCT concentrations, measured by semiquantitative and quantitative tests. Conclusions Point-of-care PCT tests may be helpful tools for distinguishing bacterial from nonbacterial causes of acute febrile illness in low-resource settings, though further studies with larger sample sizes are warranted to validate these findings and optimize test interpretation across varying PCT levels.
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Copyright 2025 The Author(s). This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. (http://creativecommons.org/licenses/by-nc-nd/4.0/)