| Autor: |
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. |
| Zdroj: |
Cancers; Oct2024, Vol. 16 Issue 20, p3450, 9p |
| Abstrakt: |
Simple Summary: Procalcitonin (PCT) is a blood biomarker that can be used to detect infections and is often combined with clinical judgment to guide antibiotic use, particularly in critically ill patients and those with respiratory infections. In this study, we aimed to evaluate how PCT levels can help guide antibiotic treatment in cancer patients with febrile neutropenia. We found that a 30% decrease in PCT levels or a repeated PCT level of ≤ 0.25 ng/mL was associated with earlier reduction of antibiotics and shorter treatment duration, without affecting patient outcomes. This suggests that monitoring PCT could safely and effectively optimize antibiotic use in these patients, reducing the risk of antibiotic resistance. Objective: 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. Design: Prospective randomized study. Methods: 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. Results: 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%; p = 0.003) and a shorter median antibiotic duration (55 h vs. 98 h; p = 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, p = 0.013). Conclusions: 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. Clinical trials identifier: NCT04983901. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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