Procalcitonin-guided protocol is not useful to manage antibiotic therapy in febrile neutropenia: a randomized controlled trial

Lima, Stella Sala Soares; Nobre, Vandack; Romanelli, Roberta Maia de Castro; Clemente, Wanessa Trindade; Bittencourt, Henrique; Melo, Ana Catarina; Salomão, Luciana Caetano Botelho; Serufo, José Carlos

doi:10.1007/s00277-016-2639-5

Cited by 35 publications

(23 citation statements)

References 26 publications

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“…However, the sensitivity of PCT was relatively low (46.9%), consistent with results of a previous study demonstrating low sensitivity of PCT in febrile neutropenia [6]. Our data support previous results of Lima et al [24] showing that PCT cut-off point of 0.5 ng/mL is correlated with bacteremia (sensitivity of 51.9% and specificity of 76.5%) in a randomized controlled trial enrolling 62 hematological adult patients who have febrile neutropenia. To obtain high sensitivity of PCT test, lower cut-off levels should be considered.…”

Section: Discussionsupporting

confidence: 93%

Serum procalcitonin as an independent diagnostic markers of bacteremia in febrile patients with hematologic malignancies

et al. 2019

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BackgroundSerum procalcitonin (PCT) and C-reactive protein (CRP) are biomarkers of infection. In patients with hematologic disorders with or without hematopoietic stem cell transplantation (HSCT), it is difficult to distinguish bloodstream infections from aseptic causes of febrile episodes. The objective of this study was to investigate diagnostic values of PCT and CRP in predicting systemic bacterial infection in patients with hematologic malignancies.MethodsClinical and laboratory data of 614 febrile episode cases from 511 patients were analyzed. Febrile episodes were classified into four groups: (1) culture-positive bacterial infection by Gram-positive cocci (GPC), (2) culture-positive bacterial infection by Gram-negative bacilli (GNB), (3) fungal infection, and (4) viral infection or a noninfectious etiology.ResultsOf 614 febrile cases, systemic bacterial infections were confirmed in 99 (16.1%) febrile episodes, including 38 (6.2%) GPC and 61 (9.9%) GNB infections. PCT levels were significantly higher in GNB infectious episodes than those in febrile episodes caused by fungal infection (0.58 ng/mL (95% CI: 0.26–1.61) vs. 0.22 ng/mL (0.16–0.38), P = 0.047). Bacterial infectious episodes showed higher PCT and CRP levels than non-bacterial events (PCT: 0.49 (0.26–0.93) ng/mL vs. 0.20 (0.18–0.22) ng/mL, P < 0.001; CRP: 76.6 (50.5–92.8) mg/L vs. 58.0 (51.1–66.5) mg/L, P = 0.036). For non-neutropenic febrile episodes, both PCT and CRP discriminated bacteremia from non-bacteremia. However, in neutropenic febrile episodes, PCT only distinguished bacteremia from non-bacteremia. In non-neutropenic episode, both PCT and CRP showed good diagnostic accuracy (AUC: 0.757 vs. 0.763). In febrile neutropenia, only PCT discriminated bacteremia from non-bacterial infection (AUC: 0.624) whereas CRP could not detect bacteremia (AUC: 0.500, 95% CI: 0.439–0.561, P > 0.05).ConclusionsIn this single-center observational study, PCT was more valuable than CRP for discriminating between bacteremia and non-bacteremia independent of neutropenia or HSCT.

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Section: Discussionsupporting

confidence: 93%

Serum procalcitonin as an independent diagnostic markers of bacteremia in febrile patients with hematologic malignancies

et al. 2019

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“…Adherence to the PCT algorithm was frequently shown to be a challenging issue both in trials and in real life, which is due to low experience and thus insecurity about interpretation and follow-up measures. Furthermore, the evidence for infections other than LRTI or sepsis is still sparse, and few trials have included patients with immunosuppression, therefore limiting the generalization of the findings for these patients [42]. These aspects were considered in the refinement of the algorithms, which is now based on clinical assessment of disease severity and probability of bacterial infection and using only one severity-specific PCT cut-off to rerate the infection probability.…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

Шуц¹,

Beishuizen²,

Бройлс³

et al. 2019

Lab. sluzh.

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Background: Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods: Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. Results: The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the

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“…However, the low sensitivity suggests PCT may not be useful as a rule‐out aid in the neutropenic patient population. A small randomized controlled trial confirmed the utility of PCT as an additional diagnostic marker for bacteremia in patients with febrile neutropenia, but it found no evidence favoring the use of PCT as an antimicrobial therapy guide . In summary, clinicians can expect lower PCT levels in patients with neutropenia compared with nonneutropenic patients, and they should utilize PCT to help confirm bacterial infection, rather than to exclude bacterial infection or guide antimicrobial therapy decisions.…”

Section: Unique Considerations For Specific Populationsmentioning

confidence: 99%

Procalcitonin Monitoring as a Guide for Antimicrobial Therapy: A Review of Current Literature

2018

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Effective antimicrobial stewardship practices are increasingly essential to best utilize the current arsenal of antimicrobials for the shortest necessary duration to minimize the development of antimicrobial resistance, secondary infections, and health care costs. Monitoring of serum procalcitonin (PCT) levels represents an effective antimicrobial stewardship strategy to differentiate bacterial infections from viral infections and noninfectious inflammatory conditions. Current literature illustrates the merits of PCT monitoring in reducing duration of antibiotic therapy without detrimental effects on mortality or infection relapses. However, the interpretation of PCT levels can be challenging, especially in light of comorbid disease states that can elevate PCT levels. This review sheds light on the utility of PCT monitoring, as well as providing insight into the practical interpretation of PCT levels. Much of the current literature surrounding PCT monitoring consists of use among patients with lower respiratory tract infections or in the critically ill. Overall, studies have demonstrated shorter antibiotic therapy durations when PCT monitoring is utilized. No studies to date have found increased rates of mortality or infection relapses, suggesting that PCT monitoring is not only effective, but also safe when used as a guide for antimicrobial therapy. Nonetheless, many conditions were shown to elevate PCT serum concentrations, even in the absence of bacterial infections, which can make interpretation of PCT concentrations challenging. Two common conditions that affect the accurate interpretation of PCT levels are renal dysfunction and congestive heart failure. Limited studies have been performed in these populations, but current available data propose the need for higher PCT thresholds in those with renal dysfunction or congestive heart failure and support utilizing PCT trends to monitor clinical improvement from bacterial infections. Evidence also suggests that PCT monitoring is cost-effective, as long as the test is ordered judiciously. In summary, PCT monitoring represents a promising antimicrobial stewardship strategy to limit exposure to unnecessary antimicrobial therapy.

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Procalcitonin-guided protocol is not useful to manage antibiotic therapy in febrile neutropenia: a randomized controlled trial

Cited by 35 publications

References 26 publications

Serum procalcitonin as an independent diagnostic markers of bacteremia in febrile patients with hematologic malignancies

Serum procalcitonin as an independent diagnostic markers of bacteremia in febrile patients with hematologic malignancies

Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

Procalcitonin Monitoring as a Guide for Antimicrobial Therapy: A Review of Current Literature

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