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Procalcitonin guided antibiotic treatment

J M Prins, T van der Poll
Better use of current antibiotics is warranted to curb increasing antimicrobial resistance rates. Procalcitonin guidance can safely reduce antibiotic usage when used to initiate or discontinue antibiotics in adult patients with a respiratory tract infection. However, the claimed reductions in antibiotic usage are mainly achieved in patients with acute bronchitis and exacerbations of COPD, conditions for which guidelines already discourage antibiotic treatment. Sequential procalcitonin measurements can also reduce the treatment duration of community-acquired pneumonia from 10-12 to 5-7 days, which is, however, already the recommended treatment duration for in- and outpatients under the current Dutch guidelines...
2016: Nederlands Tijdschrift Voor Geneeskunde
Anokhi J Kapasi, Sabine Dittrich, Iveth J González, Timothy C Rodwell
BACKGROUND: In resource limited settings acute febrile illnesses are often treated empirically due to a lack of reliable, rapid point-of-care diagnostics. This contributes to the indiscriminate use of antimicrobial drugs and poor treatment outcomes. The aim of this comprehensive review was to summarize the diagnostic performance of host biomarkers capable of differentiating bacterial from non-bacterial infections to guide the use of antibiotics. METHODS: Online databases of published literature were searched from January 2010 through April 2015...
2016: PloS One
Caspar Corti, Markus Fally, Andreas Fabricius-Bjerre, Katrine Mortensen, Birgitte Nybo Jensen, Helle F Andreassen, Celeste Porsbjerg, Jenny Dahl Knudsen, Jens-Ulrik Jensen
BACKGROUND: This study was conducted to investigate whether point-of-care (POC) procalcitonin (PCT) measurement can reduce redundant antibiotic treatment in patients hospitalized with acute exacerbation of COPD (AECOPD). METHODS: One-hundred and twenty adult patients admitted with AECOPD were enrolled in this open-label randomized trial. Patients were allocated to either the POC PCT-guided intervention arm (n=62) or the control arm, in which antibiotic therapy followed local guidelines (n=58)...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Changyang Lin, Qiyuan Pang
INTRODUCTION: To evaluate the method of procalcitonin (PCT)-guided treatment on antibiotics in acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: Database including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trails were searched to find relevant trails. Randomized and quasi-randomized trials of PCT-guided treatment in adult patients with AECOPD were included. Effects on primary outcome (i.e., antibiotic prescriptions, mortality, and clinical success) were accessed in this meta-analysis...
June 22, 2016: Clinical Respiratory Journal
Andreas Hohn, Bernhard Heising, Jan-Karl Schütte, Olaf Schroeder, Stefan Schröder
PURPOSE: In critically ill patients, length of antibiotic treatment can be effectively guided by procalcitonin (PCT) protocols. International sepsis guidelines and guidelines on antibiotic stewardship strategies recommend PCT as helpful laboratory marker for a rational use of antibiotics. A number of studies and meta-analyses have confirmed the effectiveness of PCT-protocols for shortening antibiotic treatment without compromising clinical outcome in critically ill patients. But in clinical practice, there is still uncertainty how to interpret PCT levels and how to adjust antibiotic treatment in various infectious situations, especially in the perioperative period...
June 10, 2016: Langenbeck's Archives of Surgery
A Lavrentieva, P Kontou, V Soulountsi, J Kioumis, O Chrysou, M Bitzani
The purpose of this study was to examine the hypothesis that an algorithm based on serial measurements of procalcitonin (PCT) allows reduction in the duration of antibiotic therapy compared with empirical rules, and does not result in more adverse outcomes in burn patients with infectious complications. All burn patients requiring antibiotic therapy based on confirmed or highly suspected bacterial infections were eligible. Patients were assigned to either a procalcitonin-guided (study group) or a standard (control group) antibiotic regimen...
September 30, 2015: Annals of Burns and Fire Disasters
Wei Qian, Gao-Zhong Huang
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are responsible for most mortality in patients with chronic obstructive pulmonary disease (COPD) and are caused mainly by bacterial infection. We analyzed and compared neutrophil CD64 expression (using the ratio of CD64 level in neutrophils to that in lymphocytes as an index), serum C-reactive protein (CRP), procalcitonin (PCT) levels, white blood cell (WBC) count, and neutrophil percentage among healthy subjects and patients with stable COPD or AECOPD...
August 2016: Immunological Investigations
Yuri van der Does, Maarten Limper, Stephanie C E Schuit, Marten J Poley, Joost van Rosmalen, Christian Ramakers, Peter Patka, Eric C M van Gorp, Pleunie P M Rood
BACKGROUND: Fever is a common symptom in the emergency department(ED). Fever can be caused by bacterial infections, which are treated with antibiotics. Often, bacterial infections cannot be ruled out in the ED using standard diagnostics, and empiric antibiotic treatment is started. Procalcitonin(PCT) is a biomarker for bacterial infections, but its role in an undifferentiated ED population remains unclear. We hypothesize that PCT-guided therapy may reduce antibiotics prescription in undifferentiated febrile ED patients...
2016: BMC Emergency Medicine
Angela R Branche, Edward E Walsh, Nagesh Jadhav, Rachel Karmally, Andrea Baran, Derick R Peterson, Ann R Falsey
RATIONALE: Lower respiratory tract illness (LRTI) frequently causes adult hospitalization and antibiotic overuse. Procalcitonin (PCT) treatment algorithms have been used successfully in Europe to safely reduce antibiotic use for LRTI but have not been adopted in the United States. We recently performed a feasibility study for a randomized clinical trial (RCT) of PCT and viral testing to guide therapy for non-pneumonic LRTI. OBJECTIVE: The primary objective of the current study was to understand factors influencing PCT algorithm adherence during the RCT and evaluate factors influencing provider antibiotic prescribing practices for LRTI...
2016: PloS One
Daniel Drozdov, Frank Dusemund, Beat Müller, Werner C Albrich
BACKGROUND: In 14 randomized controlled studies to date, a procalcitonin (PCT)-based algorithm has been proven to markedly reduce the use of antibiotics along with an unimpaired high safety and low complication rates in patients with lower respiratory tract infections (LRTIs). However, compliance with the algorithm and safety out of controlled study conditions has not yet been sufficiently investigated. METHODS: We performed a prospective international multicenter observational post-study surveillance of consecutive adults with community-acquired LRTI in 14 centers (Switzerland (n = 10), France (n = 3) and the United States (n = 1))...
2013: Antibiotics
Evelien de Jong, Jos A van Oers, Albertus Beishuizen, Piet Vos, Wytze J Vermeijden, Lenneke E Haas, Bert G Loef, Tom Dormans, Gertrude C van Melsen, Yvette C Kluiters, Hans Kemperman, Maarten J van den Elsen, Jeroen A Schouten, Jörn O Streefkerk, Hans G Krabbe, Hans Kieft, Georg H Kluge, Veerle C van Dam, Joost van Pelt, Laura Bormans, Martine Bokelman Otten, Auke C Reidinga, Henrik Endeman, Jos W Twisk, Ewoudt M W van de Garde, Anne Marie G A de Smet, Jozef Kesecioglu, Armand R Girbes, Maarten W Nijsten, Dylan W de Lange
BACKGROUND: In critically ill patients, antibiotic therapy is of great importance but long duration of treatment is associated with the development of antimicrobial resistance. Procalcitonin is a marker used to guide antibacterial therapy and reduce its duration, but data about safety of this reduction are scarce. We assessed the efficacy and safety of procalcitonin-guided antibiotic treatment in patients in intensive care units (ICUs) in a health-care system with a comparatively low use of antibiotics...
July 2016: Lancet Infectious Diseases
Bao-Quan Dai, Xun-Tao Yuan, Jin-Ming Liu
OBJECTIVE: To evaluate the value of serum procalcitonin (PCT) for the guidance of antibiotic therapy in children with lower respiratory tract infection (LRTI). METHODS: A prospective randomized controlled study was conducted in 396 children with LRTI who visited Weifang Maternity and Child Care Hospital. The participants were randomly assigned into a PCT group in which the antibiotic therapy was guided by serum PCT level and a control group in which the standard therapy was given according to clinical guidance...
December 2015: Zhongguo Dang Dai Er Ke za Zhi, Chinese Journal of Contemporary Pediatrics
Iliana-Maria Pantelidou, Evangelos J Giamarellos-Bourboulis
Antibiotic overconsumption and subsequent bacterial multidrug resistance are associated with increased mortality, length of hospitalisation and healthcare costs. Discontinuation of antibiotic treatment in severe infections, such as bloodstream infections (BSIs), is a demanding clinical decision. In this review, we aim to investigate the usefulness of procalcitonin (PCT) monitoring in guiding appropriate treatment duration in BSIs and its impact on clinical outcomes. Data from clinical studies conducted after 2005 that included patients with BSIs indicate that change of PCT is an early indicator for prognosis in terms of survival and, overall, support the usefulness of a PCT-guided clinical algorithm in reducing the duration of antibiotic treatment without compromising survival...
December 2015: International Journal of Antimicrobial Agents
Marie Westwood, Bram Ramaekers, Penny Whiting, Florian Tomini, Manuela Joore, Nigel Armstrong, Steve Ryder, Lisa Stirk, Johan Severens, Jos Kleijnen
BACKGROUND: Determination of the presence or absence of bacterial infection is important to guide appropriate therapy and reduce antibiotic exposure. Procalcitonin (PCT) is an inflammatory marker that has been suggested as a marker for bacterial infection. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of adding PCT testing to the information used to guide antibiotic therapy in adults and children (1) with confirmed or highly suspected sepsis in intensive care and (2) presenting to the emergency department (ED) with suspected bacterial infection...
November 2015: Health Technology Assessment: HTA
Yoel Lubell, Stuart D Blacksell, Susanna Dunachie, Ampai Tanganuchitcharnchai, Thomas Althaus, Wanitda Watthanaworawit, Daniel H Paris, Mayfong Mayxay, Thomas J Peto, Arjen M Dondorp, Nicholas J White, Nicholas P J Day, François Nosten, Paul N Newton, Paul Turner
BACKGROUND: Poor targeting of antimicrobial drugs contributes to the millions of deaths each year from malaria, pneumonia, and other tropical infectious diseases. While malaria rapid diagnostic tests have improved use of antimalarial drugs, there are no similar tests to guide the use of antibiotics in undifferentiated fevers. In this study we estimate the diagnostic accuracy of two well established biomarkers of bacterial infection, procalcitonin and C-reactive protein (CRP) in discriminating between common viral and bacterial infections in malaria endemic settings of Southeast Asia...
2015: BMC Infectious Diseases
Atabak Najafi, Ali Khodadadian, Mehdi Sanatkar, Reza Shariat Moharari, Farhad Etezadi, Arezoo Ahmadi, Farsad Imani, Mohammad Reza Khajavi
The empiric antibiotic therapy can result in antibiotic overuse, development of bacterial resistance and increasing costs in critically ill patients. The aim of the present study was to evaluate the effect of procalcitonin (PCT) guide treatment on antibiotic use and clinical outcomes of patients admitted to intensive care unit (ICU) with systemic inflammatory response syndrome (SIRS). A total of 60 patients were enrolled in this study and randomly divided into two groups, cases that underwent antibiotic treatment based on serum level of PCT as PCT group (n=30) and patients who undergoing antibiotic empiric therapy as control group (n=30)...
2015: Acta Medica Iranica
Massimo Sartelli, Fausto Catena, Luca Ansaloni, Federico Coccolini, Salomone Di Saverio, Ewen A Griffiths
BACKGROUND: Surgeons managing intra-abdominal infections should always respect the basic principles of antibiotic treatment. An adequate duration of antimicrobial therapy is important to optimize empiric therapy and minimize selective pressures favoring antimicrobial resistance. METHODS: The optimal duration of antibiotic therapy for intra-abdominal infections (IAIs) has been debated in the last years. A literature research, based on PubMed database and limited to English language publications, was performed without restriction of time or type of manuscript...
February 2016: Surgical Infections
Jaap ten Oever, Mihai G Netea, Bart-Jan Kullberg
Differentiating between inflammatory disorders is difficult, but important for a rational use of antimicrobial agents. Biomarkers reflecting the host immune response may offer an attractive strategy to predict the etiology of an inflammatory process and can thus be of help in decision making. We performed a review of the literature to evaluate the diagnostic value of inflammatory biomarkers in adult patients admitted to the hospital with suspected systemic acute infections. Elevated procalcitonin (PCT) concentrations indicate a bacterial infection in febrile patients with an auto-immune disease, rather than a disease flare...
January 2016: Journal of Infection
Silvia Martini, Fabio Tumietto, Rita Sciutti, Laura Greco, Giacomo Faldella, Luigi Corvaglia
Methicillin-resistant Staphylococcus aureus (MRSA) is an established nosocomial pathogen with frequent multidrug resistance. The immaturity of the immune system along with intravascular lines and empirical antibiotic treatments place hospitalized preterm infants at major risk of MRSA infection.We report a case of MRSA mandibular osteomyelitis complicating a persistent S. aureus bacteremia in a 23-week preterm infant. From the first weeks of life, the infant showed recurrent C-reactive protein (CRP) elevation, associated with S...
2015: Italian Journal of Pediatrics
H H Liu, J B Guo, Y Geng, L Su
Critically ill patients are frequently at risk of sepsis or inflammatory conditions. Procalcitonin (PCT) is a biomarker for critically ill patients to differentiate sepsis from non-infectious triggers of the systemic inflammatory response syndrome. It has been recently shown that PCT is a valuable tool to guide antibiotic treatment in patients with bacteria infections. However, PCT is also less than a universal and perfect biomarker, and its physiologic role remains unknown. An increase in PCT is associated not only with localized bacterial infection, but also with non-infectious disease or other microbial infections...
September 2015: Irish Journal of Medical Science
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