Utility and safety of procalcitonin in an antimicrobial stewardship program (ASP) in patients with malignancies

• Published in: European journal of clinical microbiology & infectious diseases 2012-11, Vol.31 (11), p.3041-3046
• Main Authors: Liew, Y. X., Lee, W., Cai, Y. Y., Teo, J., Tang, S. S.-L., Ong, R. W.-Q., Lim, C. L.-L., Lingegowda, P. B., Kwa, A. L.-H., Chlebicki, M. P.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Audits; Bacterial Infections - diagnosis; Bacterial Infections - drug therapy; Biological and medical sciences; Biomarkers - blood; Biomedical and Life Sciences; Biomedicine; Calcitonin - blood; Calcitonin Gene-Related Peptide; Carbapenems - therapeutic use; Clinical outcomes; Compliance; Drug Monitoring - methods; Drug stores; Female; Hospitals; Humans; Infectious diseases; Internal Medicine; Male; Medical Microbiology; Medical sciences; Middle Aged; Neoplasms - complications; Neutropenia; Patient safety; Pharmacy; Physicians; Protein Precursors - blood; Retrospective Studies; Survival Analysis; Time Factors; Treatment Outcome; Trends; Young Adult
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-012-1662-2

As data on procalcitonin utility in antibiotics discontinuation [under an antimicrobial stewardship program (ASP)] in patients with malignancies are lacking, we aimed to evaluate the utility of procalcitonin in an ASP in patients with malignancies. We conducted a retrospective review of the ASP database of all patients with malignancies in whom at least one procalcitonin level was taken and our ASP had recommended changes in carbapenem regimen, from January to December 2011. We compared clinical outcomes between two groups of patients: patients whose physicians accepted and those whose physicians rejected ASP interventions. There were 749 carbapenem cases reviewed. Ninety-nine were suggested to either de-escalate, discontinue antibiotics, or narrow the spectrum of empiric treatment, based on procalcitonin trends. While there was no statistical difference in the mortality within 30 days post-ASP intervention (accepted: 8/65 patients vs. rejected: 9/34 patients; p  = 0.076), the median duration of carbapenem therapy was significantly shorter (5 vs. 7 days; p  = 0.002). Procalcitonin use safely facilitates decisions on antibiotics discontinuation and de-escalation in patients with malignancies in the ASP.