Objective: Serial procalcitonin (PCT) monitoring has been adopted to supplement clinical judgement and help guide antibiotic therapy as part of antimicrobial stewardship programs. PCT levels peak 24 to 48 h after infection onset and decline with infection resolution. We explored the role of PCT as an infection biomarker for guiding antibiotic therapy in cancer patients hospitalized for febrile neutropenia. Design: Prospective randomized study. Methods: Patients were enrolled between October 2021 and August 2023 and received empiric intravenous broad-spectrum antibiotics (IVBSA) for at least 48 h. PCT was measured at baseline and 48–72 h after IVBSA initiation. PCT drop 48–72 h after IVBSA initiation was defined as a reduction of 30% from baseline or a PCT level < 0.25 ng/mL. De-escalation was defined as a switch from IVBSA to oral or simplified once-daily IV therapy. Results: Of the 89 patients with available PCT levels, 53 (60%) had a PCT drop, most of whom (79%) underwent IVBSA de-escalation. Compared with patients without a PCT drop, patients with a PCT drop had a higher de-escalation rate at 72 h (71% vs. 45%;p= 0.003) and a shorter median antibiotic duration (55 h vs. 98 h;p= 0.004). Patients with bacteremia had a significantly higher median PCT level than those without bacteremia (2.35 ng/mL vs. 0.370 ng/mL,p= 0.013). Conclusions: In patients with cancer and febrile neutropenia, a PCT drop was associated with earlier therapy de-escalation and shorter antibiotic duration. PCT monitoring may be useful in antimicrobial stewardship initiatives in this patient population. Clinical trials identifier: NCT04983901.
目的：作为抗菌药物管理项目的一部分，序贯监测降钙素原（PCT）已被用于辅助临床判断并指导抗生素治疗。PCT水平在感染发生后24至48小时达到峰值，并随感染消退而下降。本研究探讨PCT作为感染生物标志物在指导因发热性中性粒细胞减少症住院的癌症患者抗生素治疗中的作用。设计：前瞻性随机研究。方法：患者于2021年10月至2023年8月期间入组，均接受至少48小时的经验性静脉广谱抗生素（IVBSA）治疗。在基线及IVBSA启用后48-72小时检测PCT水平。IVBSA启用后48-72小时PCT下降定义为较基线降低30%或PCT水平<0.25 ng/mL。降阶梯治疗定义为从IVBSA转换为口服或简化的每日一次静脉治疗方案。结果：在89例可获得PCT水平的患者中，53例（60%）出现PCT下降，其中大多数（79%）接受了IVBSA降阶梯治疗。与未出现PCT下降的患者相比，PCT下降患者在72小时内的降阶梯治疗率更高（71% vs. 45%；p=0.003），中位抗生素使用时间更短（55小时 vs. 98小时；p=0.004）。菌血症患者的中位PCT水平显著高于非菌血症患者（2.35 ng/mL vs. 0.370 ng/mL，p=0.013）。结论：在合并发热性中性粒细胞减少症的癌症患者中，PCT下降与更早实施治疗降阶梯及更短的抗生素疗程相关。PCT监测可能有助于该患者群体的抗菌药物管理实践。临床试验标识符：NCT04983901。
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