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Procalcitonin-guided protocol is not useful to manage antibiotic therapy in febrile neutropenia: a randomized controlled trial

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Abstract

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.

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Acknowledgments

We would like to thank the patients, medical, nursing, and laboratory staff of the Hospital das Clínicas and School of Medicine of the Universidade Federal de Minas Gerais. We are indebted to Prof. Stephan Harbarth whose encouragement and counseling made this study possible.

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Authors and Affiliations

  1. 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

    Stella Sala Soares Lima, Vandack Nobre & José Carlos Serufo

  2. Radiotherapy Department of Instituto Mario Penna, Rua Gentios, 1350, Luxemburgo, Belo Horizonte, Minas Gerais, Brazil, CEP: 30.380-490

    Stella Sala Soares Lima

  3. 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 Nobre & José Carlos Serufo

  4. Infection Control Service of Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    Roberta Maia de Castro Romanelli & Wanessa Trindade Clemente

  5. 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 de Castro Romanelli

  6. Laboratory Medicine Department of School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    Wanessa Trindade Clemente

  7. Hematology-Oncology Division, C.H.U. Saint-Justine, 3175, Chemin de la Côte, Sainte-Catherine, Montréal, QC, H3T 1C5, Canada

    Henrique Neves da Silva Bittencourt

  8. 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 Melo & Luciana Caetano Botelho Salomão

Authors
  1. Stella Sala Soares Lima
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  2. Vandack Nobre
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  3. Roberta Maia de Castro Romanelli
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  4. Wanessa Trindade Clemente
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  5. Henrique Neves da Silva Bittencourt
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  6. Ana Catarina Mourão Melo
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  7. Luciana Caetano Botelho Salomão
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  8. José Carlos Serufo
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Corresponding author

Correspondence to Stella Sala Soares Lima.

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Ethical aspects

The Institutional Ethics Review Board approved the study protocol, and written informed consent was obtained from all participants.

Funding

This work was supported by Fundação de Amparo à Pesquisa do Estado de Minas Gerais (APQ-01956-10).

Conflict of interest

The authors declare that they have no conflict of interest.

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Lima, S.S.S., Nobre, V., de Castro Romanelli, R.M. et al. Procalcitonin-guided protocol is not useful to manage antibiotic therapy in febrile neutropenia: a randomized controlled trial. Ann Hematol 95, 1169–1176 (2016). https://doi.org/10.1007/s00277-016-2639-5

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  • DOI: https://doi.org/10.1007/s00277-016-2639-5

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