From the Department of Pediatrics, Universidad del Valle.
Clínica Imbanaco.
Pediatr Infect Dis J. 2021 Nov 1;40(11):1023-1028. doi: 10.1097/INF.0000000000003239.
Children frequently develop fever after hematopoietic stem cell transplant (HSCT). Although the etiology of many febrile episodes (FEs) is not an infection, patients often receive broad-spectrum antibiotics in response.
To improve the judicious use of antibiotics in pediatric HSCT patients, we performed a prospective cohort study of children receiving an HSCT in Clínica Imbanaco (Cali, Colombia) between September 2016 and December 2019. We assessed all FEs occurring during 3 periods (infusion, neutropenic and engraftment). We measured procalcitonin and C-reactive protein (CRP) sequentially during each FE and compared levels among patients with fever due to significant infection (FSI) versus fever not attributable to infection (FNI) in each transplant period.
There were 166 FEs in 95 patients. FSI accounted for 12%, 42% and 42% of FE during infusion, neutropenic and engraftment periods, respectively. CRP had better discriminatory capacity for FSI versus FNI in the infusion period [area under the curve (AUC) 0.80 (95% confidence interval [CI], 0.62-0.96) for a CRP level of 50 mg/L]. Neither biomarker performed well in the neutropenic period. During the engraftment period, a CRP of 65 mg/L had an AUC of 0.81 (95% CI, 0.65-0.96), while a procalcitonin level of 0.25 ng/mL had an AUC of 0.83 (95% CI, 0.63-1.0). In contrast to procalcitonin, the CRP's pattern of change throughout the first 3 days of fever in each transplant period was different in FSI compared with FNI.
Sequential measurement of biomarkers, especially CRP, may allow clinicians to more appropriately manage antibiotic use in pediatric HSCT units.
儿童在接受造血干细胞移植（HSCT）后经常会发烧。尽管许多发热事件（FE）的病因不是感染，但患者通常会接受广谱抗生素治疗。
为了提高儿科 HSCT 患者抗生素使用的合理性，我们对 2016 年 9 月至 2019 年 12 月在哥伦比亚卡利的 Clínica Imbanaco 接受 HSCT 的儿童进行了一项前瞻性队列研究。我们评估了在输注、中性粒细胞减少和植入期间发生的所有 FE。在每个 FE 期间连续测量降钙素原和 C 反应蛋白（CRP），并比较每个移植期因有意义感染（FSI）和无感染（FNI）引起发热的患者之间的水平。
95 名患者共发生 166 次 FE。FSI 分别占输注、中性粒细胞减少和植入期 FE 的 12%、42%和 42%。在输注期，CRP 对 FSI 与 FNI 的鉴别能力优于降钙素原[CRP 水平为 50mg/L 时，曲线下面积（AUC）为 0.80（95%置信区间[CI]，0.62-0.96）]。在中性粒细胞减少期，两种生物标志物的性能均不佳。在植入期，CRP 为 65mg/L 时，AUC 为 0.81（95%CI，0.65-0.96），降钙素原水平为 0.25ng/mL 时，AUC 为 0.83（95%CI，0.63-1.0）。与降钙素原不同，CRP 在每个移植期发热的前 3 天内的变化模式在 FSI 与 FNI 之间有所不同。
对生物标志物进行连续测量，特别是 CRP，可能使临床医生更适当地管理儿科 HSCT 单位的抗生素使用。
