Procalcitonin Level Can be a Useful Indicator of When Antibiotics Should be Stepped up in Children with Cancer and Fever without Source
DOI:
https://doi.org/10.31584/jhsmr.2021826Keywords:
carbapenem, febrile neutropenia, fever without source, mipenem/meropenem, procalcitoninAbstract
Objective: To assess whether procalcitonin (PCT) levels can be a reliable indicator of when it is unnecessary to step up antibiotics in children with cancer and fever without source (FWS).
Material and Methods: The medical records of children with hematologic-oncologic malignancies aged 3 months-15 years who had FWS ≥4 days and were admitted to Songklanagarind Hospital from December 2016 to February 2019 were reviewed.
Results: FWS was identified in 89 patients. PCT levels were tested in 43 patients; 21 and 22 patients had low PCT (PCT <0.5 nanograms per milliliter (ng/mL)) and high PCT (PCT ≥0.5 ng/mL) levels, respectively. The baseline characteristics of the patients including age, sex, risk of serious bacterial infection, and duration of antibiotic(s) among the 3 groups (low-PCT, high-PCT and PCT-not-tested) were not significantly different. The proportions of patients who had had their antibiotics stepped up after 4 days with conventional treatment were 65.0%, 90.9%, and 95.7% and who were stepped up to carbapenem were 38.1%, 68.2%, and 73.9% in the low-PCT, high-PCT, and PCT-not-tested groups, respectively, significantly lowest in the low-PCT group. High PCT levels were associated with sepsis with sensitivity, specificity, positive predictive value, and negative predictive value of 87.5%, 57.1%, 31.8%, and 95.2%, respectively.
Conclusion: We suggest that cancer children who have FWS without sepsis and low PCT levels do not need to have their antibiotics stepped up; however, as the sample size of this study was quite small, further studies are needed to confirm our findings and conclusion.
References
Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 Update by the Infectious Diseases Society of America. Clin Infect Dis 2011;52:e56-93.
Laoprasopwattana K, Pruekprasert P, Laosombat V, Wongchanchailert M. Clinical outcome of febrile neutropenia in children with cancer using ceftazidime and aminoglycosides. Pediatr Hematol Oncol 2007;24:595-606.
Lee JH, Kim SK, Han SB, Lee JW, Lee DG, Chung NG, et al. Increase in antibiotic-resistant gram-negative bacterial infections in febrile neutropenic children. Infect Chemother 2016;48:181-9.
Ahn S, Lee YS, Lim KS, Lee JL. Adding procalcitonin to the MASCC risk-index score could improve risk stratification of patients with febrile neutropenia. Support Care Cancer 2013; 21:2303-8.
Kern WV. Risk assessment and treatment of low-risk patients with febrile neutropenia. Clin Infect Dis 2006;42:533-40.
Giamarellou H, Giamarellos-Bourboulis EJ, Repoussis P, Galani L, Anagnostopoulos N, Grecka P, et al. Assessment of procalcitonin as a diagnostic and prognostic marker in patients with solid tumors and febrile neutropenia. Clin Microbiol Infect 2004;10:628-33.
Jimeno A, Garcia-Velasco A, del Val O, Gonzalez-Billalabeitia E, Hernando S, Hernandez R, et al. Assessment of procalcitonin as a diagnostic and prognostic marker in patients with solid tumors and febrile neutropenia. Cancer 2004;100:2462-9.
Yang M, Choi SJ, Lee J, Lee DG, Kim YJ, Park YJ, et al. Serum procalcitonin as an independent diagnostic markers of bacteremia in febrile patients with hematologic malignancies. Plos One 2019;14:e0225765.
Lima SS, Nobre V, de Castro Romanelli RM, Clemente WT, da Silva Bittencourt HN, Melo AC, et al. Procalcitonin-guided protocol is not useful to manage antibiotic therapy in febrile neutropenia: a randomized controlled trial. Ann Hematol 95:2016;1169-76.
Hatzistilianou M, Rekliti A, Athanassiadou F, Catriu D. Procalcitonin and C-reactive protein serum levels as markers of infection in a pediatric population with febrile neutropenia and cancer. Inflamm Res 2010;59:339-47.
Robinson JO, Lamoth F, Bally F, Knaup M, Calandra T, Marchetti O. Elevated procalcitonin predicts Gram-negative sepsis in haematological patients with febrile neutropenia. Plos One 2011;6:0018886.
Fleischhack G, Kambeck I, Cipic D, Hasan C, Bode U. Procalcitonin in paediatric cancer patients: its diagnostic relevance is superior to that of C-reactive protein, interleukin 6, interleukin 8, soluble interleukin 2 receptor and soluble tumour necrosis factor receptor II. Br J Haematol 2000;111:1093-102.
Engel A, Steinbach G, Kern P, Kern WV. Diagnostic value of procalcitonin serum levels in neutropenic patients with fever: comparison with interleukin-8. Scand J Infect Dis 1999;31: 185-9.
Hemming V, Jakes AD, Shenton G, Phillips B. Prospective cohort study of procalcitonin levels in children with cancer presenting with febrile neutropenia. BMC Pediatr 2017;17. doi: 10.1186/s12887-016-0766-8.
Giamarellos-Bourboulis EJ, Grecka P, Poulakou G, Anargyrou K, Katsilambros N, Giamarellou H. Assessment of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia. Clin Infect Dis 2001;32:1718-25.
Sakr Y, Sponholz C, Tuche F, Brunkhorst F, Reinhart K. Change of procalcitonin predicts clinical outcome of febrile episodes in patients with hematological malignancies. Infection 2008;36:396-407.
Weiss SL, Peters MJ, Alhazzani W, Agus MSD, Flori HR, Inwald DP, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis- Associated Organ Dysfunction in Children. Pediatr Crit Care Med 2020;21:e52-106.
Ruokonen E, Nousiainen T, Pulkki K, Takala J. Procalcitonin concentrations in patients with neutropenic fever. Eur J Clin Microbiol Infect Dis 1999;18:283-5.
Hitoglou-Hatzi S, Hatzistilianou M, Gougoustamou D, Rekliti A, Agguridaki C, Athanassiadou F, et al. The predictive and diagnostic values of procalcitonin and C-reactive protein for clinical outcome in febrile neutropenic patients. Clin Exp Med 2005;5:60-5.
van der Galien HT, Loeffen EAH, Miedema KGE, Tissing WJE. Predictive value of PCT and IL-6 for bacterial infection in children with cancer and febrile neutropenia. Support Care Cancer 2018;26:3819-26.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
