Routine Blood Tests Outperform CRP for Distinguishing Bacterial From Viral Infection in Children

Abstract

Acute infectious diseases are among the leading causes of medical consultations and hospitalizations in children worldwide. These infections are predominantly caused by viruses or bacteria, yet differentiating between the two remains a common clinical challenge. As a result, pediatricians often default to the safer option of prescribing antibiotics contributing to the growing problem of antimicrobial resistance. The objective is to assess the additional predictive value of CBC towards determining the current infection. This retrospective study used data from 906 pediatric patients aged between 2 and 14 years who were tested positive either for viral or bacterial infection between 2022 and 2026. Inclusion criteria further required availability of CBC results and CRP level measurements. These laboratory parameters as well as age were used as input features for several supervised classification models. Model performance was evaluated using AUC, sensitivity and specificity. The best performing model is XGBoost, which included all features, achieving out of-sample performance of AUC of 81.7% and sensitivity of 70.8%, specificity of 79.2%. All trained models outperform a CRP-based only decision-rule model in terms of AUC. We suggest that the decision to prescribe antibiotics should be based on a number of factors, including but not limited to CBC, some of which are not currently incorporated into routine practice.