Procalcitonin-guided protocol is not useful to manage antibiotic therapy in febrile neutropenia: a randomized controlled trial.
Febrile neutropenia (FN) requires immediate use of antibiotics (ATB), and procalcitonin (PCT) is proven to be useful in guiding antibiotic therapy in different settings. This study investigated the use of PCT as a guide for the duration of ATB in FN. A randomized controlled trial was carried out from January-December 2010. A total of 62 hematological adult patients with FN were randomized, in 1:1 ratio, into two groups: (1) PCT group: length of ATB guided by institutional protocol plus PCT dynamics, and (2) control group: duration of ATB in accordance with institutional protocol. There was no difference between groups regarding the use of ATB for the first episode of fever (HR 1.14, 95 % CI 0.66-1.95, p = 0.641), with equivalent median duration of ATB therapy (PCT group 9.0 days and control group 8.0 days, p = 0.67), and median number of days without ATB (0 days, IQR 0-2 days for both groups, p = 0.96). We observed no difference in clinical cure rate (p = 0.68), infection relapse (p = 1.0), superinfection (p = 0.85), length of hospitalization (p = 0.64), and mortality at 28 days (p = 0.39) and at 90 days (p = 0.72). Considering the cut-off of 0.5 ng/ml, PCT was correlated with bacteremia (sensitivity of 51.9 % and specificity of 76.5 %). In this randomized controlled trial, adding a PCT-guided protocol to the standard recommendations did not reduce the use of antibiotics in febrile neutropenia, although no apparent harm was caused. PCT proved to be a marker of bacteremia in this setting.
Graduate Program in Infectious Diseases and Tropical Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Rua Santa Catarina, 861/1302, Lourdes, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.170-080. stellabhz@yahoo.com.br.|Radiotherapy Department of Instituto Mario Penna, Rua Gentios, 1350, Luxemburgo, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.380-490. stellabhz@yahoo.com.br.
Stella Sala Soares
SS
Lima
Graduate Program in Infectious Diseases and Tropical Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Rua Santa Catarina, 861/1302, Lourdes, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.170-080.|Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.130-100.
Vandack
V
Nobre
Infection Control Service of Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.|Department of Pediatric Medicine of School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.130-100.
Roberta Maia
RM
de Castro Romanelli
Infection Control Service of Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.|Laboratory Medicine Department of School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Wanessa Trindade
WT
Clemente
Hematology-Oncology Division, C.H.U. Saint-Justine, 3175, Chemin de la Côte, Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
Henrique Neves
HN
da Silva Bittencourt
School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 110, 1° andar ala oeste, CCIH, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.130-100.
Ana Catarina Mourão
AC
Melo
School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 110, 1° andar ala oeste, CCIH, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.130-100.
Luciana Caetano Botelho
LC
Salomão
Graduate Program in Infectious Diseases and Tropical Medicine, Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Rua Santa Catarina, 861/1302, Lourdes, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.170-080.|Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena 190, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.130-100.
José Carlos
JC
Serufo
D000328:Adult; D000900:Anti-Bacterial Agents / Q000097:blood* / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D019468:Disease Management; D064147:Febrile Neutropenia / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002116:Calcitonin
Antibiotic; Febrile neutropenia; Infection; Procalcitonin; Treatment