降钙素原水平监测在癌症合并发热性中性粒细胞减少症患者抗生素降阶梯与管理计划中的应用

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

作者信息

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

机构信息

Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., FCT12-6043, Unit 1460, Houston, TX 77030, USA.

Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.

出版信息

Cancers (Basel). 2024 Oct 11;16(20):3450. doi: 10.3390/cancers16203450.

DOI:10.3390/cancers16203450

PMID:39456544

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11506002/

Abstract

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%; = 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).

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.

摘要

目的

连续监测降钙素原（PCT）已被用于辅助临床判断，并作为抗菌管理计划的一部分帮助指导抗生素治疗。PCT水平在感染发生后24至48小时达到峰值，并随感染消退而下降。我们探讨了PCT作为感染生物标志物在因发热性中性粒细胞减少症住院的癌症患者中指导抗生素治疗的作用。

设计

前瞻性随机研究。

方法

患者于2021年10月至2023年8月入组，接受经验性静脉注射广谱抗生素（IVBSA）治疗至少48小时。在基线时以及IVBSA开始后48 - 72小时测量PCT。IVBSA开始后48 - 72小时PCT下降定义为较基线水平降低30%或PCT水平<0.25 ng/mL。降级定义为从IVBSA转换为口服或简化的每日一次静脉治疗。

结果

在89例有可用PCT水平的患者中，53例（60%）出现PCT下降，其中大多数（79%）进行了IVBSA降级。与未出现PCT下降的患者相比，出现PCT下降的患者在72小时时的降级率更高（71%对45%；P = 0.003），且抗生素使用中位数持续时间更短（55小时对98小时；P = 0.004）。菌血症患者的PCT中位数水平显著高于无菌血症患者（2.35 ng/mL对0.370 ng/mL，P = 0.013）。