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Procalcitonin guided antibiotic treatment

Timothy C Jenkins, Jason S Haukoos, Eleanor Cotton, David Weitzenkamp, Daniel N Frank, William J Burman
In a pilot study of 22 patients with an acute bacterial skin infection, serum levels of C-reactive protein and procalcitonin tended to be elevated at presentation and declined within 3-5 days of treatment. Further study of a biomarker-guided treatment strategy to reduce antibiotic overuse in skin infections is warranted.
March 2018: Open Forum Infectious Diseases
Nusrat Shafiq, Vikas Gautam, Avaneesh Kumar Pandey, Navjot Kaur, Shubha Garg, Harish Negi, Sharonjeet Kaur, Pallab Ray, Samir Malhotra
Background & objectives: Development of antibacterial resistance and its association with antibiotic overuse makes it necessary to identify a specific and sensitive biomarker for the diagnosis of bacterial infection and guiding antibiotic therapy. Procalcitonin (PCT), as a sepsis biomarker, may play a role in guiding antibiotics treatment in hospital settings. The aim of the current meta-analysis was to analyze the utility of PCT on various outcomes of interest in inpatients. Methods: Different databases were searched for randomized controlled trials comparing PCT-guided therapy with standard therapy in admitted patients with bacterial infections...
November 2017: Indian Journal of Medical Research
Phunsup Wongsurakiat, Sirapat Tulatamakit
Background We wanted to determine the impact of combined Clinical Pulmonary Infection Score (CPIS) and a spot serum procalcitonin (PCT)-guided protocol to shorten the duration of antibiotic treatment in patients with ventilator-associated pneumonia (VAP), mainly caused by nonfermentative gram-negative bacilli (NF-GNB). Methods Patients with VAP who received appropriate antibiotics for 7 days, temperature ⩽ 37.8°C, without shock, and CPIS ⩽ 6 were allocated to the PCT group or conventional group according to the treating physicians' decisions...
January 2018: Therapeutic Advances in Respiratory Disease
Thiago Lisboa, Jorge Salluh, Pedro Povoa
Using biomarkers as a guide to tailor the duration of antibiotic treatment in respiratory infections is an attractive hypothesis assessed in several studies. Recent work aiming to summarize the evidence assessed the effect of a procalcitonin (PCT)-guided antibiotic treatment on outcomes in acute lower respiratory tract infections (LRTI), suggesting that significant reductions in antibiotic duration occur when using a PCT-guided algorithm. However, controversial evidence also suggested PCT-guided algorithms were associated with increased antibiotic duration and increased incidence of Clostridium difficile, without any impact on mortality, in real-world settings...
January 27, 2018: Critical Care: the Official Journal of the Critical Care Forum
Elyse J Watkins, James Guerrini
The FDA recently approved a procalcitonin assay for use in hospitals and EDs to help prescribers determine if an antibiotic should be prescribed and for what duration. This article reviews the use of procalcitonin testing and evidence-based medical decision-making for patients with sepsis or lower respiratory tract infections.
January 2018: JAAPA: Official Journal of the American Academy of Physician Assistants
Victor Jeger, Roxana Pop, Farschad Forudastan, Jean Pierre Barras, Markus Zuber, Rein Jan Piso
AIMS OF THE STUDY: While studies show that antibiotic treatment for uncomplicated diverticulitis seems to have no benefit, most experts advocate antimicrobial therapy for complicated diverticulitis. However, even for uncomplicated diverticulitis, most clinicians are very reluctant to withhold antibiotics. Biomarkers could help to guide antibiotic therapy as this approach has been shown to be effective for acute respiratory infections. In this diagnostic cohort study we evaluated whether procalcitonin could be a biomarker to distinguish complicated from uncomplicated cases of diverticulitis...
November 29, 2017: Swiss Medical Weekly
Yannick Wirz, Angela Branche, Michel Wolff, Tobias Welte, Vandack Nobre, Konrad Reinhart, Ann R Falsey, Pierre Damas, Albertus Beishuizen, Rodrigo O Deliberato, Yahya Shehabi, Jens-Ulrik S Jensen, Beat Mueller, Philipp Schuetz
Due to overlap of clinical findings and low sensitivity of bacterial diagnostic tests, differentiation between bacterial and viral respiratory tract infections remains challenging, ultimately leading to antibiotic overuse in this population of patients. Addition of procalcitonin, a blood biomarker expressed by epithelial cells in response to bacterial infections, to the clinical assessment leads to a reduction in inappropriate antibiotic initiation. Procalcitonin also provides prognostic information about the resolution of illness, and significant decreases over time are a strong signal for the discontinuation of antibiotics...
December 8, 2017: ACS Infectious Diseases
Radoslaw Jaworski, Ireneusz Haponiuk, Ninela Irga-Jaworska, Mariusz Steffens, Maciej Chojnicki, Konrad Paczkowski, Jacek Zielinski
PURPOSE: This retrospective cohort study aimed to identify the early postoperative kinetics of C-reactive protein (CRP) and procalcitonin (PCT) in children undergoing tetralogy of Fallot (ToF) correction. The ability of these inflammatory markers to guide rational antibiotic usage was also determined. MATERIALS AND METHODS: All consecutive children who underwent ToF correction in 2009-2016 in our referral pediatric cardiac surgery clinic in Gdansk, Poland and did not exhibit infection signs on early postoperative days (POD) were identified...
October 27, 2017: Advances in Medical Sciences
Kristina Keitel, Frank Kagoro, Josephine Samaka, John Masimba, Zamzam Said, Hosiana Temba, Tarsis Mlaganile, Willy Sangu, Clotilde Rambaud-Althaus, Alain Gervaix, Blaise Genton, Valérie D'Acremont
BACKGROUND: The management of childhood infections remains inadequate in resource-limited countries, resulting in high mortality and irrational use of antimicrobials. Current disease management tools, such as the Integrated Management of Childhood Illness (IMCI) algorithm, rely solely on clinical signs and have not made use of available point-of-care tests (POCTs) that can help to identify children with severe infections and children in need of antibiotic treatment. e-POCT is a novel electronic algorithm based on current evidence; it guides clinicians through the entire consultation and recommends treatment based on a few clinical signs and POCT results, some performed in all patients (malaria rapid diagnostic test, hemoglobin, oximeter) and others in selected subgroups only (C-reactive protein, procalcitonin, glucometer)...
October 2017: PLoS Medicine
J C Li, L Y Wang, Y F Wang, M H Mei, L Shi, M L Yao, X D Guan, B Ouyang
Objective: To evaluate the influence of serum procalcitonin in the diagnosis and treatment of pulmonary infection in patients with central nervous system injury. Methods: From October 2014 to February 2017, a retrospective study was performed. A total of 1 852 patients were screened in Department of Intensive Care Unite, First Affiliated Hospital of Sun Yat-sen University.Among them, 173 patients were identified with different kinds of infection. Finally, a total of 42 patients with pulmonary infection were enrolled...
October 10, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Wanis H Ibrahim, Kamran Mushtaq, Tasleem Raza, Anand Kartha, Ahmed O Saleh, Rayaz A Malik
OBJECTIVE: The primary outcome was to determine whether serum procalcitonin-guided antibiotic therapy can reduce antibiotic exposure in patients with an acute exacerbation of asthma presenting to the primary care facility or emergency department, or during hospital admission. The secondary outcome was the need for mechanical ventilation. METHODS: An extensive literature search was performed to identify randomized controlled clinical trials (published in English) that compared serum procalcitonin-guided antibiotic therapy versus antibiotic use according to physician's discretion for adult participants with mild, moderate, or severe acute asthma exacerbations...
December 2017: International Journal of Infectious Diseases: IJID
Philipp Schuetz, Yannick Wirz, Ramon Sager, Mirjam Christ-Crain, Daiana Stolz, Michael Tamm, Lila Bouadma, Charles E Luyt, Michel Wolff, Jean Chastre, Florence Tubach, Kristina B Kristoffersen, Olaf Burkhardt, Tobias Welte, Stefan Schroeder, Vandack Nobre, Long Wei, Heiner C Bucher, Djillali Annane, Konrad Reinhart, Ann R Falsey, Angela Branche, Pierre Damas, Maarten Nijsten, Dylan W de Lange, Rodrigo O Deliberato, Carolina F Oliveira, Vera Maravić-Stojković, Alessia Verduri, Bianca Beghé, Bin Cao, Yahya Shehabi, Jens-Ulrik S Jensen, Caspar Corti, Jos A H van Oers, Albertus Beishuizen, Armand R J Girbes, Evelien de Jong, Matthias Briel, Beat Mueller
BACKGROUND: In February, 2017, the US Food and Drug Administration approved the blood infection marker procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety of procalcitonin-guided treatment in patients with acute respiratory infections from different clinical settings. METHODS: Based on a prespecified Cochrane protocol, we did a systematic literature search on the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, and pooled individual patient data from trials in which patients with respiratory infections were randomly assigned to receive antibiotics based on procalcitonin concentrations (procalcitonin-guided group) or control...
October 13, 2017: Lancet Infectious Diseases
Philipp Schuetz, Yannick Wirz, Ramon Sager, Mirjam Christ-Crain, Daiana Stolz, Michael Tamm, Lila Bouadma, Charles E Luyt, Michel Wolff, Jean Chastre, Florence Tubach, Kristina B Kristoffersen, Olaf Burkhardt, Tobias Welte, Stefan Schroeder, Vandack Nobre, Long Wei, Heiner C Bucher, Neera Bhatnagar, Djillali Annane, Konrad Reinhart, Angela Branche, Pierre Damas, Maarten Nijsten, Dylan W de Lange, Rodrigo O Deliberato, Stella Ss Lima, Vera Maravić-Stojković, Alessia Verduri, Bin Cao, Yahya Shehabi, Albertus Beishuizen, Jens-Ulrik S Jensen, Caspar Corti, Jos A Van Oers, Ann R Falsey, Evelien de Jong, Carolina F Oliveira, Bianca Beghe, Matthias Briel, Beat Mueller
BACKGROUND: Acute respiratory infections (ARIs) comprise of a large and heterogeneous group of infections including bacterial, viral, and other aetiologies. In recent years, procalcitonin (PCT), a blood marker for bacterial infections, has emerged as a promising tool to improve decisions about antibiotic therapy (PCT-guided antibiotic therapy). Several randomised controlled trials (RCTs) have demonstrated the feasibility of using procalcitonin for starting and stopping antibiotics in different patient populations with ARIs and different settings ranging from primary care settings to emergency departments, hospital wards, and intensive care units...
October 12, 2017: Cochrane Database of Systematic Reviews
Natasa Cvetinovic, Andjelka M Isakovic, Mitja Lainscak, Hans-Durk Dungen, Natasa Markovic Nikolic, Goran Loncar
Although procalcitonin (PCT) was evaluated for the first time in the setting of heart failure (HF) in 1999, its utility in HF patients is still under examination. Patients with HF have significantly higher plasma PCT concentrations than healthy subjects and PCT levels are associated with severity of HF. It has been confirmed that higher levels of PCT are associated with worse outcomes, such as increased mortality and higher rate of rehospitalization, in HF patients with no evidence of infection. Furthermore, it has been approved that PCT-guided antibiotic treatment in HF patients reduces duration of antibiotic therapy and improves outcomes...
October 2017: Biomarkers in Medicine
Verena Gotta, Philipp Baumann, Nicole Ritz, Aline Fuchs, Gurli Baer, Jessica M Bonhoeffer, Ulrich Heininger, Gabor Szinnai, Jan Bonhoeffer
BACKGROUND: Knowledge of key drivers for antibiotic prescribing in pediatric lower respiratory tract infection (LRTI) could support rational antibiotic use. Thus, we aimed to determine the impact of clinical and laboratory factors on antibiotic prescribing in children and adolescents with febrile LRTI. METHODS: Pediatric patients from the standard care control group of a randomized controlled trial (ProPAED) investigating procalcitonin guided antibiotic treatment in febrile LRTI were included in a multivariate logistic regression analysis to evaluate the impact of laboratory and clinical factors on antibiotic prescribing...
2017: PloS One
Joel Jämsä, Tero Ala-Kokko, Virva Huotari, Pasi Ohtonen, Eeva-Riitta Savolainen, Hannu Syrjälä
PURPOSE: We were interested in whether C-reactive protein (CRP) and procalcitonin (PCT) distinguish sepsis from non-septic controls and whether a combination of CRP, PCT, and neutrophil CD64 improves identification of sepsis in the intensive care unit (ICU). MATERIALS AND METHODS: We analyzed the CRP and PCT concentrations from 27 patients with sepsis and 15 ICU controls. In addition, CD64 on neutrophils was measured using quantitative flow cytometry. We present a multiple marker analysis for sepsis diagnostics combining neutrophil CD64, CRP, and PCT using post-test analysis...
February 2018: Journal of Critical Care
Sarah Kg Tonkin-Crine, Pui San Tan, Oliver van Hecke, Kay Wang, Nia W Roberts, Amanda McCullough, Malene Plejdrup Hansen, Christopher C Butler, Chris B Del Mar
BACKGROUND: Antibiotic resistance is a worldwide health threat. Interventions that reduce antibiotic prescribing by clinicians are expected to reduce antibiotic resistance. Disparate interventions to change antibiotic prescribing behaviour for acute respiratory infections (ARIs) have been trialled and meta-analysed, but not yet synthesised in an overview. This overview synthesises evidence from systematic reviews, rather than individual trials. OBJECTIVES: To systematically review the existing evidence from systematic reviews on the effects of interventions aimed at influencing clinician antibiotic prescribing behaviour for ARIs in primary care...
September 7, 2017: Cochrane Database of Systematic Reviews
Martin Stocker, Wendy van Herk, Salhab El Helou, Sourabh Dutta, Matteo S Fontana, Frank A B A Schuerman, Rita K van den Tooren-de Groot, Jantien W Wieringa, Jan Janota, Laura H van der Meer-Kappelle, Rob Moonen, Sintha D Sie, Esther de Vries, Albertine E Donker, Urs Zimmerman, Luregn J Schlapbach, Amerik C de Mol, Angelique Hoffman-Haringsma, Madan Roy, Maren Tomaske, René F Kornelisse, Juliette van Gijsel, Eline G Visser, Sten P Willemsen, Annemarie M C van Rossum
BACKGROUND: Up to 7% of term and late-preterm neonates in high-income countries receive antibiotics during the first 3 days of life because of suspected early-onset sepsis. The prevalence of culture-proven early-onset sepsis is 0·1% or less in high-income countries, suggesting substantial overtreatment. We assess whether procalcitonin-guided decision making for suspected early-onset sepsis can safely reduce the duration of antibiotic treatment. METHODS: We did this randomised controlled intervention trial in Dutch (n=11), Swiss (n=4), Canadian (n=2), and Czech (n=1) hospitals...
August 26, 2017: Lancet
Jonas Odermatt, Natalie Friedli, Alexander Kutz, Matthias Briel, Heiner C Bucher, Mirjam Christ-Crain, Olaf Burkhardt, Tobias Welte, Beat Mueller, Philipp Schuetz
BACKGROUND: Several trials found procalcitonin (PCT) helpful for guiding antibiotic treatment in patients with lower respiratory tract infections and sepsis. We aimed to perform an individual patient data meta-analysis on the effects of PCT guided antibiotic therapy in upper respiratory tract infections (URTI). METHODS: A comprehensive search of the literature was conducted using PubMed (MEDLINE) and Cochrane Library to identify relevant studies published until September 2016...
November 27, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
Lena Ulm, Sarah Hoffmann, Darius Nabavi, Marcella Hermans, Bruno-Marcel Mackert, Frank Hamilton, Ingo Schmehl, Gerhard-Jan Jungehuelsing, Joan Montaner, Alejandro Bustamante, Mira Katan, Andreas Hartmann, Stefan Ebmeyer, Christiane Dinter, Jan C Wiemer, Sabine Hertel, Christian Meisel, Stefan D Anker, Andreas Meisel
BACKGROUND: Pneumonia is among the most common acute complications after stroke and is associated with poor long-term outcome. Biomarkers may help identifying stroke patients at high risk for developing stroke-associated pneumonia (SAP) and to guide early treatment. AIMS: This trial investigated whether procalcitonin (PCT) ultrasensitive (PCTus)-guided antibiotic treatment of SAP can improve functional outcome after stroke. METHODS: In this international, multicenter, randomized, controlled clinical trial with blinded assessment of outcomes, patients with severe ischemic stroke in the middle cerebral artery territory were randomly assigned within 40 h after symptom onset to PCTus-based antibiotic therapy guidance in addition to stroke unit care or standard stroke unit care alone...
2017: Frontiers in Neurology
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