Procalcitonin Level Monitoring in Antibiotic De-Escalation and Stewardship Program for Patients with Cancer and Febrile Neutropenia

• Published in: Cancers Vol. 16; no. 20; p. 3450
• Main Authors: Dagher, Hiba, Chaftari, Anne-Marie, Hachem, Ray, Jiang, Ying, Philip, Ann, Mulanovich, Patricia, Haddad, Andrea, Lamie, Peter, Wilson Dib, Rita, John, Teny M, Dailey Garnes, Natalie J M, Ali, Shahnoor, Chaftari, Patrick, Raad, Issam I
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 11-10-2024; MDPI
• Subjects: Algorithms; Antibiotic resistance; Antibiotics; Bacteremia; Bacterial infections; Biomarkers; Cancer; Cancer patients; Clinical outcomes; Clinical trials; Dosage and administration; Drug therapy; Gram-positive bacteria; Infections; Neutropenia; Patient safety; Patients; Procalcitonin; Respiratory tract infection; Sepsis; United States; United States > US; fever; neutropenia; procalcitonin; cancer; febrile neutropenia; biomarker
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers16203450

Serial procalcitonin (PCT) monitoring has been adopted to supplement clinical judgement and help guide antibiotic therapy as part of antimicrobial stewardship programs. PCT levels peak 24 to 48 h after infection onset and decline with infection resolution. We explored the role of PCT as an infection biomarker for guiding antibiotic therapy in cancer patients hospitalized for febrile neutropenia.
Prospective randomized study.
Patients were enrolled between October 2021 and August 2023 and received empiric intravenous broad-spectrum antibiotics (IVBSA) for at least 48 h. PCT was measured at baseline and 48-72 h after IVBSA initiation. PCT drop 48-72 h after IVBSA initiation was defined as a reduction of 30% from baseline or a PCT level < 0.25 ng/mL. De-escalation was defined as a switch from IVBSA to oral or simplified once-daily IV therapy.
Of the 89 patients with available PCT levels, 53 (60%) had a PCT drop, most of whom (79%) underwent IVBSA de-escalation. Compared with patients without a PCT drop, patients with a PCT drop had a higher de-escalation rate at 72 h (71% vs. 45%;
= 0.003) and a shorter median antibiotic duration (55 h vs. 98 h;
= 0.004). Patients with bacteremia had a significantly higher median PCT level than those without bacteremia (2.35 ng/mL vs. 0.370 ng/mL,
= 0.013).
In patients with cancer and febrile neutropenia, a PCT drop was associated with earlier therapy de-escalation and shorter antibiotic duration. PCT monitoring may be useful in antimicrobial stewardship initiatives in this patient population.
NCT04983901.