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Procalcitonin and antibiotic

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
Mark E Nunnally, Arpit Patel
PURPOSE OF REVIEW: Sepsis-3 guidelines have implications in a deeper understanding of the biopathology of the disease. Further, the review focuses on timely topics and new literature on fluid resuscitation, the value of steroids in sepsis, and new therapeutic options such as angiotensin II, vitamin C, and thiamine as well as the emerging role of procalcitonin (PCT) in managing antibiotics. RECENT FINDINGS: Traditional therapies such as type of crystalloid fluid administration and steroid therapy for sepsis are currently under re-evaluation...
January 31, 2019: Current Opinion in Anaesthesiology
M Feng, S L Zhang, Z J Liang, Y L Wang, X C Zhao, C Gao, H Guo, J Luo
OBJECTIVE: To investigate the diagnostic role of complement C3, complement C4, C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), neutrophil CD64 (nCD64) index, lymphocyte subsets and their combination in differentiating bacterial infection from disease relapse in systemic lupus erythematosus (SLE). METHODS: The above biomarkers in 36 hospitalized SLE patients with bacterial infection and 45 with lupus flare without infection were retrospectively studied...
February 2, 2019: Lupus
Björn Kleibrink, Christian Taube
Respiratory tract infections and acute bronchitis are one of the major indications for which antibiotics are prescribed. As most of respiratory tract infections are caused by viruses and antibiotic therapy is rarely indicated. Reasons for the unnecessary prescription of antibiotics in this patient population are false expectations regarding the course and duration of common cold symptoms and especially coughing. After exclusion of severe diseases acute coughing should be treated with a symptom-oriented therapy...
February 2019: Deutsche Medizinische Wochenschrift
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
Rita Murri, Eleonora Taddei, Roberto Cauda, Massimo Fantoni
No abstract text is available yet for this article.
January 15, 2019: Future Microbiology
Akihiro Fujita, Shinji Tanishima, Yoshihiro Kato, Ryota Teshima, Hideki Nagashima
Background: Musculoskeletal infections are often seen in the daily practice of orthopedics. Several markers [white blood cell (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT)] have been used for diagnosing these infections. However, these markers may be elevated due to surgery or trauma, and may not be infection-related. These markers also show drug-dependent dynamics during infection that differ from its usual dynamics. Such situations make diagnosis of infections difficult, and Cluster of Differentiation 64 (CD64) has been brought to attention...
December 2018: Yonago Acta Medica
Daniel C Richter, Alexandra Heininger, Karsten Schmidt, Thomas Schmoch, Michael Bernhard, Philipp Mayer, Markus A Weigand, Thorsten Brenner
Sepsis and septic shock represent medical emergencies with persistently high mortality rates. According to the lately revised Surviving Sepsis Campaign (SSC) guidelines, focus identification/pathogen detection and the initial administration of broad-spectrum antibiotics are to be secluded within one hour after recognition of the symptoms of sepsis. However, there is dispute concerning the so called hour-1 bundle. Being a core aspect of focus identification, imaging modalities mainly depend on the suspected site of infection and the individual patient...
January 2019: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Jennifer Townsend, Victoria Adams, Panagis Galiatsatos, David Pearse, Hardin Pantle, Mary Masterson, Flora Kisuule, Elsen Jacob, Catherine Kiruthi, Paul Ortiz, Albert Agbanlog, Robert Jurao, Sam Stern, Seema Nayak, Michael Melgar, Jacob Sama, Jillian Irwin, Cyrus Mazidi, Kevin Psoter, Robin McKenzie
Background: European trials using procalcitonin (PCT)-guided antibiotic therapy for patients with lower respiratory tract infections (LRTIs) have demonstrated significant reductions in antibiotic use without increasing adverse outcomes. Few studies have examined PCT for LRTIs in the United States. Methods: In this study, we evaluated whether a PCT algorithm would reduce antibiotic exposure in patients with LRTI in a US hospital. We conducted a controlled pre-post trial comparing an intervention group of PCT-guided antibiotic therapy to a control group of usual care...
December 2018: Open Forum 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
Vladimir P Zav'yalov, Heli Hämäläinen-Laanaya, Timo K Korpela, Tony Wahlroos
BACKGROUND: In 2015, the 68th World Health Assembly declared that effective, rapid, low-cost diagnostic tools were needed for guiding optimal use of antibiotics in medicine. This review is devoted to interferon-inducible myxovirus resistance proteins as potential biomarkers for differentiating viral from bacterial infections. CONTENT: After viral infection, a branch of the interferon (IFN)4 -induced molecular reactions is triggered by the binding of IFNs with their receptors, a process leading to the activation of mx1 5 and mx2 , which produce antiviral Mx proteins (MxA and MxB)...
December 28, 2018: Clinical Chemistry
Matteo Bassetti, Alessandro Russo, Elda Righi, Elisabetta Dolso, Maria Merelli, Federica D'Aurizio, Assunta Sartor, Francesco Curcio
Bloodstream infections (BSI) and their evolution to sepsis or septic shock are one of the most important causes of morbidity and mortality; for this reason, arapid recognition and diagnosis of these infections are crucial to improve patients' outcome. Area covered: Procalcitonin (PCT) is considered an important biomarker for diagnosis of infection, routinely used to identify patients developing severe bacterial infections. In this scenario, management of BSI is complicated by the increasing rate of multidrug-resistantstrains, and an early recognition of severe infections is mandatory...
February 2019: Expert Review of Anti-infective Therapy
Susanna Esposito, Victoria Elisa Rinaldi, Alberto Argentiero, Edoardo Farinelli, Marta Cofini, Renato D'Alonzo, Antonella Mencacci, Nicola Principi
Introduction: Among neonates and infants <3 months of age with fever without a source (FWS), 5% to 15% of cases are patients with fever caused by a serious bacterial infection (SBI). To favour the differentiation between low- and high-risk infants, several algorithms based on analytical and clinical parameters have been developed. The aim of this review is to describe the management of young infants with FWS and to discuss the impact of recent knowledge regarding FWS management on clinical practice...
2018: Mediators of Inflammation
Ann P OʼRourke, Sara A Buckman, David C Evans, Andrew J Kerwin, Emily A Breunig, Daniel E Bütz
BACKGROUND: We have developed a new, noninvasive predictive marker for onset of infection in surgical intensive care unit (ICU) patients. The exhaled CO2/CO2 ratio, or breath delta value (BDV), has been shown to be an early marker for infection in a proof of concept human study and in animal models of bacterial peritonitis. In these studies, the BDV changes during onset and progression of infection, and these changes precede physiological changes associated with infection. Earlier diagnosis and treatment will significantly reduce morbidity, mortality, hospitalization costs, and length of stay...
January 2019: Journal of Trauma and Acute Care Surgery
Jennifer L Cole
Objective: Most positive studies in procalcitonin (PCT) utilization were done in large, tertiary medical centers. Furthermore, there is a paucity of data describing the implementation process. This article is the first to describe in detail the implementation process and initial outcomes after 6 months of PCT testing in a rural, 65-bed, primary hospital. Methods: Education before and during PCT implementation as well as facility rollout are described. Initial outcomes were assessed using a before and after quasi-experimental study design comparing 2 identical 6-month time periods: May to October 2016 and May to October 2017...
December 2018: Hospital Pharmacy
Lei Zhu, Lun Dong, Yuping Li, Hengzhu Zhang, Xingdong Wang, Xiaoguang Liu, Zhenfei Teng, Boming Xia, Peng Zhang
OBJECTIVE: To evaluate the values of CSF and serum PCT for the diagnosis of intracranial infection after craniotomy and the relationship between them, and explore the PCT value about the application in the clinical antibiotics guidance. METHODS: Reviewing the incidence of intracranial infection in 21 craniotomy patients from the Subei People Hospital of Northern Jiangsu Province. CSF samples and venous blood were collected for the analysis. Diagnostic parameters were calculated via the ROC curves, and inflammatory indicators were analyzed before and after the application of antibiotics in the infection group...
December 11, 2018: World Neurosurgery
Jinxiang Wang, Bin Cao
PURPOSE OF REVIEW: This review summarizes the latest discoveries regarding the use of clinical indicators and biomarkers to guide antibiotic use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and it analyzes the advantages and disadvantages of various indicators and markers. RECENT FINDINGS: For AECOPD patients admitted to emergency departments and medical wards, procalcitonin (PCT)-guided antibiotic therapy reduced antibiotic use without adverse outcomes...
March 2019: Current Opinion in Pulmonary Medicine
Borja Gomez, Haydee Diaz, Alba Carro, Javier Benito, Santiago Mintegi
OBJECTIVES: To determine the performance of procalcitonin (PCT), C reactive protein (CRP) and absolute neutrophil count (ANC) in identifying invasive bacterial infection (IBI) among well-appearing infants ≤21 days old with fever without source and no leukocyturia. To compare this performance with that in those 22-90 days old. DESIGN: Substudy of a prospective single-centre registry performed between September 2008 and August 2017. SETTING: Paediatric emergency department of a tertiary teaching hospital...
November 29, 2018: Archives of Disease in Childhood
Kevin J Downes, Julie C Fitzgerald, Emily Schriver, Craig L K Boge, Michael E Russo, Scott L Weiss, Fran Balamuth, Sherri E Kubis, Pam Tolomeo, Warren B Bilker, Jennifer H Han, Ebbing Lautenbach, Susan E Coffin, Jeffrey S Gerber
Background: Biomarkers can facilitate safe antibiotic discontinuation in critically ill patients without bacterial infection. Methods: We tested the ability of a biomarker-based algorithm to reduce excess antibiotic administration in patients with systemic inflammatory response syndrome (SIRS) without bacterial infections (uninfected) in our pediatric intensive care unit (PICU). The algorithm suggested that PICU clinicians stop antibiotics if (1) C-reactive protein <4 mg/dL and procalcitonin <1 ng/mL at SIRS onset and (2) no evidence of bacterial infection by exam/testing by 48 hours...
November 22, 2018: Journal of the Pediatric Infectious Diseases Society
Young Kyung Yoon, Min Ja Kim, Kyung Sook Yang, Soo-Youn Ham
The aim of this study is to evaluate the usefulness of serum procalcitonin (PCT) as a diagnostic biomarker for distinguishing pneumonia from pulmonary edema in patients presenting with pulmonary infiltrates on chest radiography.A comparative study was performed retrospectively in a university-affiliated hospital, from May, 2013 to April, 2015. Adult patients (≥18 years) who showed pulmonary infiltrates on chest radiography and had blood tests with C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), PCT, and N-terminal pro-b-type natriuretic peptide (NT-proBNP) on admission were included in the study...
November 2018: Medicine (Baltimore)
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