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Comparative Analysis of Procalcitonin and C-Reactive Protein in Bloodstream Infections Among Febrile Neutropenic
Tanya Pandey1, RajKumar Kalyan1, Tanya Sachan1
1Microbiology, King George's Medical University, Lucknow, IND.
Insights
Procalcitonin (PCT) is a better biomarker than C-reactive protein (CRP) for detecting bloodstream infections in pediatric cancer patients with febrile neutropenia. Early PCT use can improve infection management and patient outcomes.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Febrile neutropenia is a critical chemotherapy complication in pediatric cancer.
- Early bloodstream infection (BSI) diagnosis is vital for managing febrile neutropenia.
- Biomarkers like procalcitonin (PCT) and C-reactive protein (CRP) aid in BSI detection.
Purpose of the Study:
- To compare the diagnostic performance of PCT and CRP in pediatric cancer patients with febrile neutropenia.
- To assess the utility of PCT and CRP in identifying bloodstream infections.
- To evaluate the correlation of PCT levels with clinical outcomes.
Main Methods:
- Prospective observational study of 106 pediatric patients with chemotherapy-induced febrile neutropenia.
- Bloodstream infections were identified and characterized (Gram-negative, Gram-positive, fungal).
- Diagnostic accuracy of PCT and CRP was compared using sensitivity, specificity, and AUC.
Main Results:
- PCT levels were significantly higher in Gram-negative BSIs compared to Gram-positive BSIs (p<0.01).
- PCT demonstrated superior diagnostic accuracy (AUC 0.93) versus CRP (AUC 0.76).
- Elevated PCT correlated with intensive care admission, prolonged hospitalization, and delayed antibiotic de-escalation (p<0.001).
Conclusions:
- Procalcitonin is a more reliable biomarker than CRP for early BSI detection in febrile neutropenic pediatric cancer patients.
- PCT shows particular efficacy in identifying Gram-negative bacteremia.
- Routine PCT use may enhance infection management and improve clinical outcomes in pediatric oncology.
Abstract:
Febrile neutropenia is a serious complication in pediatric cancer patients receiving chemotherapy, often leading to bloodstream infections, where early diagnosis is critical. This prospective observational study, conducted at a tertiary care hospital in Northern India from August 2023 to July 2024, included 106 pediatric patients with chemotherapy-induced febrile neutropenia to compare the diagnostic performance of procalcitonin (PCT) and C-reactive protein (CRP). Bloodstream infections were confirmed in 32 patients (30.2%), comprising 20 Gram-negative, 11 Gram-positive, and one fungal isolate. PCT levels were significantly higher in Gram-negative infections (19.27 ± 10.56 ng/mL) than in Gram-positive infections (2.57 ± 2.35 ng/mL, p<0.01), while CRP showed less specificity (150.0 ± 35.2 mg/L vs. 45.0 ± 20.8 mg/L, p<0.05). PCT demonstrated superior diagnostic accuracy (sensitivity 89.2%, specificity 83.5%, AUC 0.93) compared to CRP (sensitivity 76.3%, specificity 62.7%, AUC 0.76). Elevated PCT levels correlated with higher intensive care admissions, prolonged hospital stays, and delayed antibiotic de-escalation (p<0.001). These findings indicate that PCT is a more reliable biomarker than CRP for early detection of bloodstream infections in febrile neutropenic pediatric cancer patients, particularly for Gram-negative bacteremia, and its routine incorporation may enhance infection management and clinical outcomes in pediatric oncology.
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