Procalcitonin Response May Help Guide Antimicrobial Decisions for Patients With Cancer, Sepsis

Extending antibiotic therapy beyond a week may not be necessary in those patients with cancer and sepsis who present with a lower procalcitonin level at baseline

NEW ORLEANS — Physicians may be able to use procalcitonin response as a way to guide their treatment of patients with cancer who are experiencing sepsis or bloodstream infections.

In an oral abstract presented at IDWeek 2016, Hanine El Haddad, MD, and colleagues from the University of Texas MD Anderson Cancer Center in Houston reiterated a common theme during the meeting: resistance to antibiotics is becoming problematic, so examining judicious ways to use antibiotics will be key to overcoming this clinical challenge.

The investigators examined procalcitonin (PCT) level data on 189 patients with cancer who presented to MD Anderson Cancer Center with fever and sepsis or bloodstream infections between July 2009 and July 2010.  The researchers evenly divided 60 of those patients into 2 study groups: one group (n=20) received 7 days or less of intravenous antibiotics and the second group (n=40) received more than 7 days of antibiotic treatment.

“Analysis showed no significant difference in outcomes between patients receiving different durations of IV antibiotics, including microbiological eradication (85% vs 90%, P =.62), relapse (8% vs 11%, P >.99), deep-seated infection (15% vs 15%, P >.99), and infection-related mortality during the 3-month follow-up period (0% vs 5%, P >.99),” the researchers wrote in their study abstract.

The researchers noted some study limitations, specifically that their data did not account for oral antibiotic use and that their data were derived for a post-hoc analysis of a previously conducted observation study.

During her presentation, Dr El Haddad said: “In febrile cancer patients with low baseline PCT levels of less than .25 or a decrease of 80% from baseline, a short IV antimicrobial duration has the same outcomes, including mortality, clinical resolution of symptoms, and relapse rates when compare with those on a longer course.” 

The researchers concluded that their results suggest that extending antibiotics beyond a week may not be necessary in those patients with cancer and sepsis who present with a lower PCT level at baseline, and using these markers may be an effective strategy toward reducing unnecessary antibiotic use.


1. El Haddad H, Micheal M, Hachem R, et al. The role of procalcitonin in guiding antimicrobial therapy duration in cancer patients with sepsis or bloodstream infections. Presented at: ID Week 2016. New Orleans, LA. October 26-31, 2016.  Abstract 72.