Procalcitonin Level Can be a Useful Indicator of When Antibiotics Should be Stepped up in Children with Cancer and Fever without Source

Abstract

Objective: To assess whether procalcitonin (PCT) levels can be a reliable indicator of when it is unnecessary to step up antibiotics in children with cancer and fever without source (FWS). Material and Methods: The medical records of children with hematologic-oncologic malignancies aged 3 months-15 years who had FWS ≥4 days and were admitted to Songklanagarind Hospital from December 2016 to February 2019 were reviewed. Results: FWS was identified in 89 patients. PCT levels were tested in 43 patients; 21 and 22 patients had low PCT (PCT <0.5 nanograms per milliliter (ng/mL)) and high PCT (PCT ≥0.5 ng/mL) levels, respectively. The baseline characteristics of the patients including age, sex, risk of serious bacterial infection, and duration of antibiotic(s) among the 3 groups (low-PCT, high-PCT and PCT-not-tested) were not significantly different. The proportions of patients who had had their antibiotics stepped up after 4 days with conventional treatment were 65.0%, 90.9%, and 95.7% and who were stepped up to carbapenem were 38.1%, 68.2%, and 73.9% in the low-PCT, high-PCT, and PCT-not-tested groups, respectively, significantly lowest in the low-PCT group. High PCT levels were associated with sepsis with sensitivity, specificity, positive predictive value, and negative predictive value of 87.5%, 57.1%, 31.8%, and 95.2%, respectively. Conclusion: We suggest that cancer children who have FWS without sepsis and low PCT levels do not need to have their antibiotics stepped up; however, as the sample size of this study was quite small, further studies are needed to confirm our findings and conclusion.

Keywords

• carbapenem
• febrile neutropenia
• fever without source
• imipenem/meropenem
• procalcitonin