Accuracy of CD64 expression on neutrophils and monocytes in bacterial infection diagnosis at pediatric intensive care admission

  • Alberto García-SalidoEmail author
  • A. Martínez de Azagra-Garde
  • M. A. García-Teresa
  • G. De Lama Caro-Patón
  • M. Iglesias-Bouzas
  • M. Nieto-Moro
  • I. Leoz-Gordillo
  • C. Niño-Taravilla
  • M. Sierra-Colomina
  • G. J. Melen
  • M. Ramírez-Orellana
  • A. Serrano-González
Original Article


The CD64 receptor has been described as an interesting bacterial infection biomarker. Its expression has not been studied in previously healthy children admitted to pediatric critical care unit (PICU). Our objective was firstly to describe the CD64 expression and secondly study its diagnostic accuracy to discriminate bacterial versus viral infection in this children. We made a prospective double-blind observational study (March 2016–February 2018). A flow cytometry (FC) was done from peripheral blood at PICU admission. We studied the percentage of CD64+ neutrophils and the CD64 mean fluorescence intensity (MFI) on neutrophils (nCD64) and monocytes (mCD64). Statistical analyses were performed with non-parametric tests (p < 0.05). Twenty children in the bacterial infection group (BIG) and 25 in the viral infection group (VIG). Children in BIG showed higher values of CD64+ neutrophils (p = 0.000), nCD64 (p = 0.001), and mCD64 (p = 0.003). In addition, CD64+ neutrophils and nCD64 expression have positive correlation with procalcitonin and C reactive protein. The nCD64 area under the curve (AUC) was 0.83 (p = 0.000). The %CD64+ neutrophils showed an AUC of 0.828 (p = 0.000). The mCD64 AUC was 0.83 (p = 0.003). The nCD64 and %CD64+ neutrophils also showed higher combined values of sensitivity (74%) and specificity (90%) than all classical biomarkers.In our series CD64 expression allows to discriminate between bacterial and viral infection at PICU admission. Future studies should confirm this and be focused in the study of CD64 correlation with clinical data and its utility as an evolution biomarker in critical care children.


Viral infection Bacterial infection Critical care Flow cytometry CD64 Sensitivity Specificity 



We are grateful to all the medical doctors, nurses, and nurse assistants working in our PICU. We extend our appreciation to all the children who participated in this study, as well as their caregivers for their patience and understanding.


Funding was provided by “Fundación de Investigación Biomédico”, Hospital Infantil Universitario Niño Jesús.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee for clinical research, Hospital Infantil Universitario Niño Jesús.

Informed consent

The blood samples were extracted after parents or legal guardians consent at admission in pediatric critical care unit. Also, the children were recruited by this procedure.

Supplementary material

10096_2019_3497_FIG3_ESM.png (1.4 mb)
Fig. S1

Three flow cytometry dot-plots representing CD64 expression on leukocytes surface. The leukocytes are gated by side scatter characteristics (SSC) and CD64 expression. The positive CD64 region is indicated by a striped arrow. A: healthy control, no expression on surface in neutrophils and lymphocytes. The lymphocytes do not express CD64 so they act as an internal negative control in each dot-plot chart. Monocytes are always positive to CD64 and its mean fluorescence intense (MFI) is 5556 and change in case of infection. B: children with viral infection. The lymphocytes are negative to CD64. The neutrophils has move to the right and 83% of them have CD64 expression on surface. The MFI of CD64 in neutrophils is 1800 and the MFI on monocytes is 8638. C: children with bacterial infection. The lymphocytes are negative to CD64. The CD64 expression on neutrophils is increased. Now 100% of neutrophils are CD64 positive and MFI is 9551. The CD64 MFI in monocytes is 15,556. (PNG 1396 kb)

10096_2019_3497_MOESM2_ESM.tif (1.7 mb)
High Resolution Image (TIF 1777 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Alberto García-Salido
    • 1
    Email author
  • A. Martínez de Azagra-Garde
    • 1
  • M. A. García-Teresa
    • 1
  • G. De Lama Caro-Patón
    • 1
  • M. Iglesias-Bouzas
    • 1
  • M. Nieto-Moro
    • 1
  • I. Leoz-Gordillo
    • 1
  • C. Niño-Taravilla
    • 1
  • M. Sierra-Colomina
    • 1
  • G. J. Melen
    • 2
  • M. Ramírez-Orellana
    • 2
  • A. Serrano-González
    • 1
  1. 1.Pediatric Critical Care UnitHospital Infantil Universitario Niño JesúsMadridSpain
  2. 2.Department of Pediatric Hematology and OncologyHospital Infantil Universitario Niño JesúsMadridSpain

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