Procalcitonin-guided protocol is not useful to manage antibiotic therapy in febrile neutropenia: a randomized controlled trial
Procalcitonin-guided protocol is not useful to manage antibiotic therapy in febrile neutropenia: a randomized controlled trial
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降钙素原指导方案对于管理发热性中性粒细胞减少症的抗生素治疗没有用：一项随机对照试验
DOI：
10.1007/s00277-016-2639-5
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发表时间：
2016
影响因子：
3.5
通讯作者：
J. Serufo
中科院分区：
文献类型：
--
作者：
S. S. S. Lima;V. Nobre;R. M. Castro Romanelli;W. Clemente;Henrique Neves Silva Bittencourt;Ana Catarina Mourão Melo;Luciana Caetano Botelho Salomão;J. Serufo
发热性中性粒细胞减少症 (FN) 需要立即使用抗生素 (ATB)，降钙素原 (PCT) 被证明可有效指导不同情况下的抗生素治疗。本研究调查了使用 PCT 作为 FN 中 ATB 持续时间的指导。 2010 年 1 月至 12 月进行了一项随机对照试验。总共 62 名患有 FN 的血液学成年患者按 1:1 的比例随机分为两组：（1）PCT 组：根据机构方案加 PCT 动态指导的 ATB 持续时间；（2）对照组：根据机构方案的 ATB 持续时间。在首次发烧时使用 ATB 方面，各组之间没有差异（HR 1.14，95% CI 0.66–1.95，p= 0.641），ATB 治疗中位持续时间相当（PCT 组 9.0 天，对照组 8.0 天，p= 0.67），以及不使用 ATB 的中位天数（0 天，IQR）两组均 0–2 天，p= 0.96）。我们观察到临床治愈率 (p= 0.68)、感染复发 (p= 1.0)、重复感染 (p= 0.85)、住院时间 (p= 0.64) 以及 28 天 (p= 0.39) 和 90 天 (p= 0.72) 的死亡率没有差异。考虑到 0.5 ng/ml 的截止值，PCT 与菌血症相关（敏感性为 51.9%，特异性为 76.5%）。在这项随机对照试验中，在标准建议中添加 PCT 指导方案并没有减少发热性中性粒细胞减少症中抗生素的使用，尽管没有造成明显的危害。 PCT 被证明是这种情况下菌血症的标志物。
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.