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Routine Use of Biomarkers to Rationalize Antibiotic Use During Febrile Episodes in Pediatric Bone Marrow Transplantation Units.

PMID: 34636797 (view PubMed database entry)
DOI: 10.1097/inf.0000000000003239 (read at publisher's website )

Jessica F Toro, Eliana Peña, Oscar Ramírez, Pio López, Carlos A Portilla, Eduardo López-Medina,

<h4>Background</h4>Children frequently develop fever after hematopoietic stem cell transplant (HSCT). Although the etiology of many febrile episodes (FEs) is not an infection, patients often receive broad-spectrum antibiotics in response.<h4>Methods</h4>To improve the judicious use of antibiotics in pediatric HSCT patients, we performed a prospective cohort study of children receiving an HSCT in Clínica Imbanaco (Cali, Colombia) between September 2016 and December 2019. We assessed all FEs occurring during 3 periods (infusion, neutropenic and engraftment). We measured procalcitonin and C-reactive protein (CRP) sequentially during each FE and compared levels among patients with fever due to significant infection (FSI) versus fever not attributable to infection (FNI) in each transplant period.<h4>Results</h4>There were 166 FEs in 95 patients. FSI accounted for 12%, 42% and 42% of FE during infusion, neutropenic and engraftment periods, respectively. CRP had better discriminatory capacity for FSI versus FNI in the infusion period [area under the curve (AUC) 0.80 (95% confidence interval [CI], 0.62-0.96) for a CRP level of 50 mg/L]. Neither biomarker performed well in the neutropenic period. During the engraftment period, a CRP of 65 mg/L had an AUC of 0.81 (95% CI, 0.65-0.96), while a procalcitonin level of 0.25 ng/mL had an AUC of 0.83 (95% CI, 0.63-1.0). In contrast to procalcitonin, the CRP's pattern of change throughout the first 3 days of fever in each transplant period was different in FSI compared with FNI.<h4>Conclusion</h4>Sequential measurement of biomarkers, especially CRP, may allow clinicians to more appropriately manage antibiotic use in pediatric HSCT units.

Pediatr Infect Dis J (The Pediatric infectious disease journal)
[2021, 40(11):1023-1028]

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