Real-World Application of a Procalcitonin Monitoring Protocol in a Pediatric Intensive Care Unit.

OBJECTIVE: Procalcitonin (PCT) is a biomarker used as an indicator for inflammation and bacterial infections. In October 2018, our PICU implemented a PCT monitoring protocol incorporating cutoffs established in previous studies to help guide antibiotic decision-making in patients undergoing sepsis evaluation. The study objective was to evaluate adherence to the protocol with regard to PCT monitoring and antibiotic use. METHODS: This retrospective review included PICU patients with systemic inflammatory response syndrome ages > 1 month to 18 years with at least 1 PCT level and blood culture obtained during the 9 months following protocol implementation. Patients were excluded if they received < 48 hours of antibiotic therapy, were neutropenic, or had antibiotics initiated at another hospital. Patients were evaluated for protocol adherence, defined as antibiotic continuation or discontinuation per protocol guidance without excess PCT monitoring. Descriptive statistics were employed. RESULTS: Out of 100 patients evaluated, 50 patients were included. Full adherence was observed in 17 patients (34%). Reasons for non-adherence were excess PCT monitoring (54.5%), antibiotic continuation (30.3%), or both (15.2%). Of patients who were non-adherent due to antibiotic continuation, 61.5% had a positive respiratory viral panel (RVP). A total of 49 excess PCT levels were drawn, resulting in an additional $2,000 in health care costs and $15,000 in patient charges. CONCLUSIONS: Overall, the impact of our PCT monitoring protocol was difficult to evaluate due to non-adherence, but it highlights potential areas of focus for improving PCT monitoring and antimicrobial stewardship, such as inclusion of RVP results.

Benzene exposure and non-Hodgkin lymphoma: a meta-analysis of epidemiologic studies.

OBJECTIVE: To conduct a meta-analysis of studies of benzene exposure and non-Hodgkin lymphoma (NHL). METHODS: A total of 8 cohort and 14 case-control studies were analyzed. RESULTS: Meta-analysis of any benzene exposure resulted in a summary relative risk estimate (SRRE) of 1.02 (95% CI: 0.94 to 1.12). The SRRE changed minimally when only data representing the highest level of benzene exposure were analyzed after an a priori data extraction protocol, using cumulative exposure as the optimum metric (SRRE = 1.08, 95% CI: 0.93 to 1.24). Meta-analysis of five studies that reported results for 60 or more ppm-years of cumulative exposure yielded an SRRE of 1.08 (95% CI: 0.36 to 3.24). Similarly, an SRRE of 1.04 (95% CI: 0.96 to 1.12) for each 25 ppm-year increment of benzene exposure was observed. CONCLUSIONS: The results from this meta-analysis are not supportive of an independent association between benzene exposure and NHL.

Therapeutic radiation for lymphoma: risk of malignant mesothelioma.

BACKGROUND: Ionizing radiation has been used since the 1950s to treat a variety of cancers. Cancer patients who are treated with radiotherapy have shown increased risks for a variety of second malignancies, including mesothelioma, in several recent reports. The only existing study of Hodgkin lymphoma (HL) and subsequent mesothelioma had a short observation period. METHODS: The authors used Surveillance, Epidemiology, and End Results data over a 30-year period to identify patients with HL and non-Hodgkin lymphoma (NHL) who also were diagnosed with mesothelioma. Standardized incidence ratios (SIR) and absolute excess risks were calculated by sex and treatment modality for both types of lymphoma. RESULTS: Twenty-six patients were identified who had mesothelioma as second primaries based on 21,881 diagnoses of HL and 101,001 diagnoses of NHL. There was a statistically significant increase in mesothelioma (4 diagnoses; SIR, 6.59; 95% confidence interval [95% CI], 1.79-16.87) among men with HL who received radiation, but no women survivors were identified who had a diagnosis of mesothelioma. For NHL survivors, there was a nonsignificant excess of mesothelioma among men (SIR, 1.91; 95% CI, 0.77-3.93) and women (SIR, 3.75; 95% CI, 0.77-10.95) who had received radiation treatment. There were no increases among patients who were unirradiated. CONCLUSIONS: Mesothelioma rates for patients who had received radiotherapy were increased for survivors of HL and NHL. No increases were observed among the unirradiated. These findings and the existing body of supporting studies confirmed that radiotherapy is a cause of mesothelioma.