978. Can Procalcitonin (PCT) Distinguish Infectious Fever from Tumor-Related Fever in Non-Neutropenic Cancer Patients (NNCP)?
Session: Poster Abstract Session: Clinical Studies of Bacterial Infection
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • 978_LauraClaburn_sm.pdf (1.8 MB)
  • Background:  PCT has been suggested to be diagnostic of bacterial infections.  Given the fact that most of the PCT studies were conducted in neutropenic febrile cancer patients, we investigated the role of PCT in distinguishing tumor-related fever from infectious fever in the NNCP. 

    Methods:  Between June 2009 and July 2010, we studied 256 NNCP with fever (³38.3ºC).  PCT was tested on plasma on the day of fever and 4 to 10 days and subsequently 4 to 7 thereafter.  Patients were classified as having bloodstream infections (bacteremia or fungemia), LBI (ex., pneumonia, wound infection, urinary tract infection), probable bacterial infections and no microbiologic or clinical evidence of infection.  PCT levels of plasma were measured in the Kryptor machine in accordance with manufacturer’s guidelines.

    Results: There were 36 patients with bloodstream infections (29 bacteremia and 7 fungemias) with a median PCT of 0.87 (range 0.08-81.95) which was significantly higher than patients with no infection (P=0.03), localized infection (P=0.04). Furthermore, PCT did predict those patients with bacterial infections who responded to antibiotics (P<0.0001) when initial baseline PCT was compared to follow-up PCT 4-7 days after the initiation of antibiotics. However, PCT did not distinguish those patients with localized bacterial infections (median PCT 0.29; range is 0.75-154.7) from those patients with no infection (median PCT 0.32; range 0.075-68.6; P=0.69). Patients with stage 4 cancer and metastasis had a median PCT of 0.4 (range 0.075-3.256) which was significantly higher than the median PCT of 0.14 (0.75-15.30) for patients with cancer stages 1, 2, or 3 and no metastasis (P=0.002). In addition, among the 86 patients with stage 4 cancer and metastasis PCT failed to differentiate patients with localized bacterial infection from no infection (P=0.48) and the same was true for the 43 patients with the stages 1, 2, 3 and no metastasis (P=0.15).

    Conclusion:  PCT is a predictor of bloodstream infections and bacteremia in cancer patients. However, it fails to distinguish a tumor-related fever often associated with liver metastasis from fever related to a localized infection in non-neutropenic cancer patients.


    Subject Category: D. Diagnostic microbiology

    William Shomali, MD, Ramez Bahu, MD, Ying Jiang, MS, Alex Hanania, Sammy Raad, Ray Hachem, MD, Anne-Marie Chaftari, MD and Issam Raad, MD, Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX

    Disclosures:

    W. Shomali, None

    R. Bahu, None

    Y. Jiang, None

    A. Hanania, None

    S. Raad, None

    R. Hachem, None

    A. M. Chaftari, None

    I. Raad, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.