High procalcitonin level is related to blood stream infections, gram-negative pathogens, and ICU admission in infections of adult febrile cancer patients.

Abstract

Background: Blood stream infection (BSI) represent a life-threatening condition. Thus, we aimed to investigate the role of procalcitonin (PCT) and C-reactive protein (CRP) tests in adult febrile patients with BSI and other clinical infections in hospitalized cancer cases.

Methods: Blood culture (BC) testing was performed using BACTEC 9120. Identification and antibiotic susceptibility were done by Vitek 2®. Multiplex PCR for the detection of carbapenemases genes produced by Enterobacteriaceae was carried out including KPC, NDM, IMP, VIM, and Oxa-48 genes. Measurement of CRP was done via particle-enhanced immunoturbidimetric assay using Cobas C6000 autoanalyzer. PCT level was measured using the electrochemiluminescence immunoassay.

Results: Out of 101 febrile hospitalized adult cancer cases with clinical infection, 50 had positive BC, and 51 were positive for other infections (27 localized bacterial and 24 viral infections) with a negative BC. At a PCT cut-off value of 0.5 ng/mL, PCT median values were significantly higher in BSI patients than those with other infections (p = 0.004), specifically with gram-negative BSIs (p = 0.007). Higher PCT values were significantly related to ICU admission and poor response to therapy, p = 0.004 and 0.002, respectively. The difference in CRP values between patients with BSI and other febrile cases was not statistically significant, p = 0.922.

Conclusion: Higher PCT values were significantly related to blood stream infections, gram-negative pathogens, ICU admission, and poor response to therapy. Procalcitonin could be used to assign severity of infection and monitor response to antimicrobial therapy in high-risk patients, thus reducing days of antibiotics days.