Impact of a Procalcitonin Guided Antibiotic Management Strategy in Pediatric Sickle Cell Patients With Fever

Area of Science:

• Pediatric Hematology
• Infectious Disease Management
• Biomarker Utilization

Background:

• Febrile pediatric patients with sickle cell disease (SCD) often receive prolonged antibiotic courses.
• Acute chest syndrome (ACS) and vaso-occlusive crisis (VOC) are common complications requiring careful management.
• Procalcitonin (PCT) is a biomarker used to guide antibiotic therapy.

Purpose of the Study:

• To assess the impact of procalcitonin (PCT) on antibiotic duration in febrile pediatric patients with SCD.
• To evaluate PCT's effect on antibiotic use specifically in patients with ACS and/or VOC.

Main Methods:

• A multicenter, retrospective cohort study compared two groups of pediatric SCD patients: one using PCT and one not.
• Antibiotic durations were compared between the PCT and no-PCT cohorts.
• Secondary analyses focused on patients with ACS and/or VOC.

Main Results:

• Overall mean antibiotic duration showed no significant difference between the PCT (4.2 days) and no-PCT (4.7 days) cohorts.
• In patients with ACS, the PCT cohort received significantly shorter antibiotic durations (6 days vs. 9.7 days).
• Patients with both VOC and ACS also showed reduced antibiotic durations in the PCT cohort (5.6 days vs. 9.3 days).
• Regression analysis indicated higher odds of longer antibiotic duration in the no-PCT group for ACS and VOC+ACS cases.

Conclusions:

• Procalcitonin (PCT) did not significantly alter overall antibiotic durations in febrile pediatric SCD patients.
• PCT use was associated with a significant reduction in antibiotic duration for patients with ACS or VOC and ACS, averaging 3.7 fewer days.
• These findings suggest PCT can help optimize antibiotic stewardship in specific SCD complications.