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Procalcitonin guided antibiotic treatment

Philipp Schuetz, Albertus Beishuizen, Michael Broyles, Ricard Ferrer, Gaetan Gavazzi, Eric Howard Gluck, Juan González Del Castillo, Jens-Ulrik Jensen, Peter Laszlo Kanizsai, Andrea Lay Hoon Kwa, Stefan Krueger, Charles-Edouard Luyt, Michael Oppert, Mario Plebani, Sergey A Shlyapnikov, Giulio Toccafondi, Jennifer Townsend, Tobias Welte, Kordo Saeed
Background Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols...
February 6, 2019: Clinical Chemistry and Laboratory Medicine: CCLM
Angela Branche, Olivia Neeser, Beat Mueller, Philipp Schuetz
PURPOSE OF REVIEW: There is convincing evidence linking antibiotic-stewardship efforts which include the infection marker procalcitonin (PCT) to more rational use of antibiotics with improvements in side-effects and clinical outcomes. This is particularly true in the setting of respiratory infection and sepsis. Yet, some recent trials have shown no benefit of PCT-guided care. Our aim was to discuss the benefits and limitations of using PCT for early infection recognition, severity assessment and therapeutic decisions in individual patients based on most the recent study data...
January 14, 2019: Current Opinion in Infectious Diseases
Olivia Neeser, Angela Branche, Beat Mueller, Philipp Schuetz
BACKGROUND: Adding procalcitonin (PCT) to antibiotic stewardship algorithms may improve antibiotic use. PCT protocols, however, need to be adapted to clinical settings and patient populations. AIMS: to review PCT use in different medical settings and patient populations. SOURCES: most recent trials and meta-analyses investigating PCT for antibiotic stewardship were reviewed. CONTENT: Several trials found PCT-guided antibiotic stewardship to reduce antibiotic exposure and associated side-effects among patients with respiratory infection and sepsis...
January 4, 2019: Clinical Microbiology and Infection
Zisis Balmpouzis, Eleni Diamanti, Antonios Kritikos, Benoit Guery, Laurent P Nicod
Respiratory tract infections represent a major cause of morbidity and mortality despite the progress made in their diagnosis and treatment. Since the clinical presentation of a viral or bacterial infection is often similar, the identification of a biomarker that could guide the clinician whether or not to introduce an antibiotic therapy is crucial. C-reactive protein and procalcitonin are the most commonly used biomarkers as a diagnostic tool for respiratory tract infections. New biomarkers show promising results for assessing the severity of infection and identifying patients at risk for complications...
November 14, 2018: Revue Médicale Suisse
Michelle M A Kip, Jos A van Oers, Arezoo Shajiei, Albertus Beishuizen, A M Sofie Berghuis, Armand R Girbes, Evelien de Jong, Dylan W de Lange, Maarten W N Nijsten, Maarten J IJzerman, Hendrik Koffijberg, Ron Kusters
BACKGROUND: Procalcitonin (PCT) testing can help in safely reducing antibiotic treatment duration in intensive care patients with sepsis. However, the cost-effectiveness of such PCT guidance is not yet known. METHODS: A trial-based analysis was performed to estimate the cost-effectiveness of PCT guidance compared with standard of care (without PCT guidance). Patient-level data were used from the SAPS trial in which 1546 patients were randomised. This trial was performed in the Netherlands, which is a country with, on average, low antibiotic use and a short duration of hospital stay...
November 13, 2018: Critical Care: the Official Journal of the Critical Care Forum
Hiang Ping Chan, Tow Keang Lim
PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Acute exacerbations of COPD (AECOPD) are major driver for healthcare utilization with each exacerbation begetting the next exacerbation. It is, therefore, important to treat each episode effectively to prevent the next. However, this can be challenging as AECOPD result from complex interactions between host, environment and infective agents. The benefits of starting antibiotics in AECOPD, which are not life-threatening (e...
November 9, 2018: Current Opinion in Pulmonary Medicine
Marc A Meier, Angela Branche, Olivia L Neeser, Yannick Wirz, Sebastian Haubitz, Lila Bouadma, Michel Wolff, Charles E Luyt, Jean Chastre, Florence Tubach, Mirjam Christ-Crain, Caspar Corti, Jens-Ulrik S Jensen, Rodrigo O Deliberato, Kristina B Kristoffersen, Pierre Damas, Vandack Nobre, Carolina F Oliveira, Yahya Shehabi, Daiana Stolz, Michael Tamm, Beat Mueller, Philipp Schuetz
Background: Whether procalcitonin (PCT)-guided antibiotic management in patients with positive blood cultures is safe remains understudied. We performed a patient level meta-analysis to investigate effects of PCT-guided antibiotic management in patients with bacteremia overall and stratified based on type of pathogen. Methods: We extracted and analysed individual data of 523 patients with positive blood cultures included in 13 trials (7 studies evaluating patients with acute respiratory illnesses, 6 studies patients with sepsis), in which patients were randomly assigned to receive antibiotics based on PCT levels (PCT group) or a control group...
October 25, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Lotte Steuten, Janne Mewes, Isabelle Lepage-Nefkens, Hubertus Vrijhoef
Antibiotics (AB) can reduce morbidity and mortality in the treatment of patients with sepsis and chronic obstructive pulmonary disease (COPD) exacerbations. Yet, AB overuse or misuse increases antibiotic resistance (ABR) and Clostridium difficile infections (CDI). This study projected the expected impact of a procalcitonin (PCT) biomarker testing strategy on incremental ABR cases and CDI, and costs of care in a population of patients hospitalized with suspected sepsis or a COPD exacerbation, in three European countries: the United Kingdom, Germany, and the Netherlands...
September 2018: Omics: a Journal of Integrative Biology
Milagros Dianti, Carlos M Luna
PURPOSE OF REVIEW: Clinical and laboratory parameters are useful tools for the diagnosis, follow-up and evaluation of resolution, and to predict outcomes when measured at different time-points onset and serially during follow-up in patients with hospital-acquired pneumonia and/or ventilator-associated pneumonia (HAP/VAP). RECENT FINDINGS: Both, the 2017 ERS/ESICM/ESCMID/Asociación Latino Americana de Tórax (EEEAG) and the 2016 IDSA/ATS guidelines (IAG) for the management of HAP/VAP recommend using clinical criteria alone, rather than biomarkers for diagnosis...
October 2018: Current Opinion in Critical Care
Yannick Wirz, Marc A Meier, Lila Bouadma, Charles E Luyt, Michel Wolff, Jean Chastre, Florence Tubach, Stefan Schroeder, Vandack Nobre, Djillali Annane, Konrad Reinhart, Pierre Damas, Maarten Nijsten, Arezoo Shajiei, Dylan W deLange, Rodrigo O Deliberato, Carolina F Oliveira, Yahya Shehabi, Jos A H van Oers, Albertus Beishuizen, Armand R J Girbes, Evelien de Jong, Beat Mueller, Philipp Schuetz
BACKGROUND: The clinical utility of serum procalcitonin levels in guiding antibiotic treatment decisions in patients with sepsis remains unclear. This patient-level meta-analysis based on 11 randomized trials investigates the impact of procalcitonin-guided antibiotic therapy on mortality in intensive care unit (ICU) patients with infection, both overall and stratified according to sepsis definition, severity, and type of infection. METHODS: For this meta-analysis focusing on procalcitonin-guided antibiotic management in critically ill patients with sepsis of any type, in February 2018 we updated the database of a previous individual patient data meta-analysis which was limited to patients with respiratory infections only...
August 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
Philipp Schuetz, Rebekka Bolliger, Meret Merker, Mirjam Christ-Crain, Daiana Stolz, Michael Tamm, Charles E Luyt, Michel Wolff, Stefan Schroeder, Vandack Nobre, Konrad Reinhart, Angela Branche, Pierre Damas, Maarten Nijsten, Rodrigo O Deliberato, Alessia Verduri, Bianca Beghé, Bin Cao, Yahya Shehabi, Jens-Ulrik S Jensen, Albertus Beishuizen, Evelien de Jong, Matthias Briel, Tobias Welte, Beat Mueller
Although evidence indicates that use of procalcitonin to guide antibiotic decisions for the treatment of acute respiratory infections (ARI) decreases antibiotic consumption and improves clinical outcomes, algorithms used within studies had differences in PCT cut-off points and frequency of testing. We therefore analyzed studies evaluating procalcitonin-guided antibiotic therapy and propose consensus algorithms for different respiratory infection types. Areas covered: We systematically searched randomized-controlled trials (search strategy updated on February 2018) on procalcitonin-guided antibiotic therapy of ARI in adults using a pre-specified Cochrane protocol and analyzed algorithms from 32 trials that included 10,285 patients treated in primary care settings, emergency departments (ED), and intensive care units (ICU)...
July 2018: Expert Review of Anti-infective Therapy
Nikolaos-Dimitrios Pantzaris, Diamantina-Xanthi Spilioti, Aikaterini Psaromyalou, Ioanna Koniari, Dimitrios Velissaris
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major complication in COPD patients which can be triggered by bacterial or viral infections, environmental pollutants and other causes. Procalcitonin (PCT), a peptide that markedly increases in cases of bacterial infection, has been extensively investigated as a biomarker in the diagnosis, prognosis and treatment in patients with AECOPD. A number of studies published in the last decade, tried to investigate whether PCT levels can differentiate between bacterial and other causes of exacerbations, if they can be used as a guide for optimal antibiotic therapy and if they can be a tool in the assessment of the severity and the need for further interventions in the management of those patients...
July 2018: Journal of Clinical Medicine Research
X Y Wang, J Zhang, L Liu, Z Ji, C Chen, J Y Yang, M Y Li
Objective: To compare and analyze the clinical characteristics and laboratory parameters of central nervous system (CNS) infection caused by different Gram-stained bacteria after craniocerebral surgery, and to provide a preliminary basis for early anti-infection treatment to reduce the use of extended-spectrum antibiotics and the generation of resistant strains. Methods: A single center retrospective study was conducted to investigate the clinical data of patients with intracranial infection after craniocerebral surgery from January 2012 to December 2016 in PLA general hospital...
May 29, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Y van der Does, M Limper, K E Jie, S C E Schuit, H Jansen, N Pernot, J van Rosmalen, M J Poley, C Ramakers, P Patka, E C M van Gorp, P P M Rood
OBJECTIVES: Overuse of broad-spectrum antibiotics in emergency departments (EDs) results in antibiotic resistance. We determined whether procalcitonin (PCT) -guided therapy can be used to reduce antibiotic regimens in EDs by investigating efficacy, safety and accuracy. METHODS: This was a non-inferiority multicentre randomized clinical trial, performed in two Dutch hospitals. Adult patients with fever ≥38.2°C (100.8°F) in triage were randomized between standard diagnostic workup (control group) and PCT-guided therapy, defined as standard workup with the addition of one single PCT measurement...
December 2018: Clinical Microbiology and Infection
Andreas Hohn, Nina Balfer, Bernhard Heising, Sabine Hertel, Jan C Wiemer, Marcel Hochreiter, Stefan Schröder
BACKGROUND: In randomised controlled trials, procalcitonin (PCT)-guided antibiotic treatment has been proven to significantly reduce length of antibiotic therapy in intensive care unit (ICU) patients. However, concern was raised on low protocol adherence and high rates of overruling, and thus the value of PCT-guided treatment in real clinical life outside study conditions remains unclear. In this study, adherence to a PCT protocol to guide antibiotic treatment in patients with severe sepsis and septic shock was analysed...
June 4, 2018: Annals of Intensive Care
Seung Ji Kang, Uh Jin Kim, Seong Eun Kim, Joon Hwan An, Mi Ok Jang, Dae-Seong Myung, Kyung-Hwa Park, Sook-In Jung, Sung Bum Cho, Hee-Chang Jang, Young Eun Joo
This prospective observational study aimed at investigating the role of procalcitonin (PCT) in diagnosing bacterial infection and guiding antibiotic therapy for hepatocellular carcinoma (HCC) patients with fever after transarterial chemoembolization (TACE) and/or radiofrequency ablation (RFA). Ninety-seven cases (84 patients) were enrolled. Serum PCT, C-reactive protein (CRP), and white blood cell (WBC) counts were measured on the day of fever onset (day 0) and days 1, 3, 5, and 7 of fever. Empirical antibiotics were initiated only if PCT was ≥0...
2018: Disease Markers
Patricia S Fontela, Shauna O'Donnell, Jesse Papenburg
PURPOSE OF REVIEW: We aim to review recent literature about the use of biomarkers to guide the initiation and duration of antibiotic treatments for suspected bacterial infections. RECENT FINDINGS: Several good quality meta-analyses show that procalcitonin can be safely used to guide antibiotic-related decisions, especially for respiratory infections, thereby decreasing unnecessary antibiotic exposure. Furthermore, the use of CRP-based algorithms to guide antibiotic initiation in primary care patients with acute respiratory infections is associated with a reduction in antibiotic use without an increase in adverse events...
August 2018: Current Opinion in Infectious Diseases
David T Huang, Donald M Yealy, Michael R Filbin, Aaron M Brown, Chung-Chou H Chang, Yohei Doi, Michael W Donnino, Jonathan Fine, Michael J Fine, Michelle A Fischer, John M Holst, Peter C Hou, John A Kellum, Feras Khan, Michael C Kurz, Shahram Lotfipour, Frank LoVecchio, Octavia M Peck-Palmer, Francis Pike, Heather Prunty, Robert L Sherwin, Lauren Southerland, Thomas Terndrup, Lisa A Weissfeld, Jonathan Yabes, Derek C Angus
BACKGROUND: The effect of procalcitonin-guided use of antibiotics on treatment for suspected lower respiratory tract infection is unclear. METHODS: In 14 U.S. hospitals with high adherence to quality measures for the treatment of pneumonia, we provided guidance for clinicians about national clinical practice recommendations for the treatment of lower respiratory tract infections and the interpretation of procalcitonin assays. We then randomly assigned patients who presented to the emergency department with a suspected lower respiratory tract infection and for whom the treating physician was uncertain whether antibiotic therapy was indicated to one of two groups: the procalcitonin group, in which the treating clinicians were provided with real-time initial (and serial, if the patient was hospitalized) procalcitonin assay results and an antibiotic use guideline with graded recommendations based on four tiers of procalcitonin levels, or the usual-care group...
July 19, 2018: New England Journal of Medicine
Juliane Hey, Philippe Thompson-Leduc, Noam Y Kirson, Louise Zimmer, Dana Wilkins, Bernie Rice, Irena Iankova, Alexander Krause, Sophie A Schonfeld, Christopher R DeBrase, Samuel Bozzette, Philipp Schuetz
Although effective for bacterial lower respiratory tract infections (LRTIs), antibiotic treatment is often incorrectly prescribed for non-bacterial LRTIs. Procalcitonin has emerged as a promising biomarker to diagnose bacterial infections and guide antibiotic treatment decisions. As part of a regulatory submission to the U.S. Food and Drug Administration, this systematic review and meta-analysis summarizes the effects of procalcitonin-guided antibiotic stewardship on antibiotic use and clinical outcomes in adult LRTI patients...
July 26, 2018: Clinical Chemistry and Laboratory Medicine: CCLM
Christophe Van Dijck, Erika Vlieghe, Janneke Arnoldine Cox
Objective: To review the effectiveness of antibiotic stewardship interventions in hospitals in low- and middle-income countries. Methods: We searched MEDLINE®, Embase®, Cochrane Central Register of Controlled Trials and regional indexes for studies of interventions to improve appropriate prescribing and use of antibiotics for hospitalized patients in low- and middle-income countries. We included controlled trials, controlled before-and-after studies and interrupted time-series studies published up to December 2017...
April 1, 2018: Bulletin of the World Health Organization
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