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Biomarkers of infection and septic shock in neutropenic patients

Abstract number: P1761

Jeddi R., Ben Amor R., Aissaoui L., Thabet L., Kacem K., Bouteraâ W., Ben Abid H., Bel Hadjali Z., Meddeb B.

Procalcitonin and C-reactive protein are the most markers of inflammation used in the diagnosis of infection. We aimed at evaluating the diagnostic and prognostic value for infection of semi-quantitative PCT (>0.5, >2 and >10 ng/ml), CRP (N < 6 mg/l), serum bicarbonate (N: 24–26 mmol/L), serum lactate (N < 2.2 mmol/L) and phosphataemia (N:0.8–1.4 mmol/L).

50 neutropenic febrile episodes were noted among 27 patients with acute leukaemia. All patients presented neutropenia (ANC < 0.5×109/L) lasting for more than 7 days. They were on oral anti-bacterial (polymixin B, gentamicin) and anti-fungal (fungizone) prophylaxis. The first neutropenic febrile episode was treated with Piperacillin-Tazobactam and Polymixin B IV, if the patient remain febrile at 48 hour from the start of this first line the fungizone iv is added. Imipenem is introduced in case of non response and finally glycopeptides are introduced according to the IDSA criteria [1]. Severe sepsis and septic shock are defined according to the criteria of the consensus conference of the ACCP/SCCM [2]. Consecutive sample for PCT (semi-quantitative test, BRAHAMS), CRP, Phosphataemia, Serum lactate, and serum bicarbonate were measured at each neutropenic febrile episode.

Seven episodes (14%) were clinically documented: pneumonia (4), neutropenic enterocolitis (1), mucositis (1) and skin infection (1). Microbiologically documented infection (30%) were due to 9 Gram- and 6 Gram+: Klebsiella (7), Acinetobacter (1), E. coli (1), Staphylococcus (6). Fever of unknown origin accounted for the remaining 28 febrile episodes. 6 episodes (12%) were complicated with septic shock, with infection related mortality of 18.5% (5/27 patients).

PCT < 0.5 ng/ml was noted in 18 (36%) febrile episodes, whearas high level (>10 ng/ml) are noted in 11 episodes. Median level of each biomarker was: CRP 88.8 mg/L (range, 2.2–183 mg/L), Serum lactate 2.3 mmol/L (range, 0.8–3.3 mmol/L), Serum bicarbonate 24.3 mmol/L (range, 9.4–32.1 mmol/L), and phosphataemia 1.08 mmol/L (range, 9.4–32.1 mmol/L).

PCT > 0.5 ng/ml (p = 0.004; OR = 6.6) and CRP > 100 mg/L (p = 0.008; OR = 6.1) were correlated with microbiologically and/or clinically documented infection. CRP > 100 mg/L correlates with Gram- infection (p = 0.045). PCT > 10 ng/ml (p = 0.017; OR 10.5) and serum lactate >3 mmol (p = 0.04; OR = 16) are associated with occurrence of septic shock.

Several level of PCT correlated with infection and severity and is useful to monitor in neutropenic setting.

References

1. Clin Infect Dis 2002;34:730–751.

2. Crit Care Med 1992;20:864–874.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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