Procalcitonin as a marker of Gram-negative bloodstream infections in hematological patients with febrile neutropenia

Abstract

The aim of this study was to explore the predictive value of procalcitonin (PCT) in Gram-negative bloodstream infections (BSIs) in hematological patients with febrile neutropenia. A total of 1466 samples (396 blood culture (BC)-positive, 1052 BC-negative, and 18 contaminated specimens) were included, comprising 268 Gram-negative, 88 Gram-positive, 19 fungal, and 21 polymicrobial BSIs. Median PCT value (0.72 ng/mL; IQR: 0.23–3.87) was significantly higher in Gram-negative than Gram-positive (0.34 ng/mL; IQR: 0.14–2.23; p < .01), or fungal (0.27 ng/mL; IQR: 0.13–0.40; p < .01) BSIs. In mono-microbial BSIs, the best PCT cutoff distinguishing Gram-negative BSIs from all other fever causes was 0.56 ng/ml, with a specificity of 76.8%. PCT levels were significantly higher in BSIs from multidrug-resistant (MDR) Gram-negative strains than from non-MDR (p < .01). This study confirms that elevated PCT may predict Gram-negative BSIs in hematological patients with febrile neutropenia, and demonstrates higher PCT levels in MDR Gram-negative BSIs in these patients.

Keywords:

• Procalcitonin
• bloodstream infections
• febrile neutropenia
• Gram-negative bacteria
• multidrug-resistant bacteria

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org//10.1080/10428194.2019.1581928.

Additional information

Funding

This work was supported by the construction project of Fujian medical center of hematology [Min201704], the National Natural Science Foundation of China [81700131], the Natural Science Foundation of Fujian Province [2018J01312], and the National and Fujian Provincial Key Clinical Specialty Discipline Construction Program, P.R.C [2011-1018, 2012-149]. The authors would like to thank Dr. Martine Torres for her critical reading of the manuscript and editorial help.