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Procalcitonin guided antibiotic treatment

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https://www.readbyqxmd.com/read/28711318/procalcitonin-guided-decision-making-for-duration-of-antibiotic-therapy-in-neonates-with-suspected-early-onset-sepsis-a-multicentre-randomised-controlled-trial-neopins
#1
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...
July 12, 2017: Lancet
https://www.readbyqxmd.com/read/28665787/effects-of-procalcitonin-testing-on-antibiotic-use-and-clinical-outcomes-in-patients-with-upper-respiratory-tract-infections-an-individual-patient-data-meta-analysis
#2
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...
June 29, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28484421/the-randomized-controlled-strawinski-trial-procalcitonin-guided-antibiotic-therapy-after-stroke
#3
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
https://www.readbyqxmd.com/read/28480770/an-update-on-the-pharmacotherapeutic-management-of-lower-respiratory-tract-infections
#4
Mario Cazzola, Paola Rogliani, Stefano Aliberti, Francesco Blasi, Maria Gabriella Matera
Our knowledge about lower respiratory tract infections (LRTIs) has improved substantially in the last years, but the management of respiratory infections is still a challenge and we are still far from using precision medicine in their treatment. Areas covered: The approaches developed in recent years to improve the pharmacotherapeutic management of LRTIs, such as novel diagnostic assays to facilitate medical decision-making, attempts for selecting an optimal empiric antibiotic regimen, and the role of new and possibly unproven adjunctive therapies, are described...
July 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28471695/current-use-and-potential-role-of-procalcitonin-in-the-diagnostic-work-up-and-follow-up-of-febrile-neutropenia-in-hematological-patients
#5
REVIEW
Benedetto Bruno, Alessandro Busca, Stefano Vallero, Stefania Raviolo, Nicola Mordini, Luca Nassi, Alessandro Cignetti, Ernesta Audisio, Moreno Festuccia, Alessandra Corsetti, Lorella Depaoli, Maura Faraci, Concetta Micalizzi, Silvia Corcione, Massimo Berger, Francesco Saglio, Paola Caropreso, Giulio Mengozzi, Vincenzo Squadrone, Francesco Giuseppe De Rosa, Luisa Giaccone
Febrile neutropenia (FN) represents a life-threatening complication in hematological malignancies. Its etiology is most often due to infections even though FN of other origins, such as tumor-related fever and non-infectious inflammation, should rapidly be ruled out. Initially, C-reactive protein and, more recently, procalcitonin (PCT) have been proposed as useful biomarkers for differential diagnosis. PCT was shown to be a good biomarker of bacterial infections and their clinical outcomes. Definition of standard cut-offs and design of PCT-guided treatment protocols remain however to be defined...
June 2017: Expert Review of Hematology
https://www.readbyqxmd.com/read/28426811/procalcitonin-for-selecting-the-antibiotic-regimen-in-outpatients-with-low-risk-community-acquired-pneumonia-using-a-rapid-point-of-care-testing-a-single-arm-clinical-trial
#6
Mar Masiá, Sergio Padilla, Victoria Ortiz de la Tabla, Matilde González, Cristina Bas, Félix Gutiérrez
OBJECTIVE: We aimed to assess the role of procalcitonin (PCT) to guide the initial selection of the antibiotic regimen for low-risk community-acquired pneumonia (CAP). METHODS: A single-arm clinical trial was conducted including outpatients with CAP and Pneumonia Severity Index risk classes I-II. Antimicrobial selection was based on the results of PCT measured with a rapid point-of-care testing. According to serum PCT levels, patients were assigned to two treatment strategies: oral azithromycin if PCT was <0...
2017: PloS One
https://www.readbyqxmd.com/read/28388301/procalcitonin-biomarker-algorithm-reduces-antibiotic-prescriptions-duration-of-therapy-and-costs-in-chronic-obstructive-pulmonary-disease-a-comparison-in-the-netherlands-germany-and-the-united-kingdom
#7
Marloes E van der Maas, Gertjan Mantjes, Lotte M G Steuten
Antibiotics are often recommended as treatment for patients with chronic obstructive pulmonary disease (COPD) exacerbations. However, not all COPD exacerbations are caused by bacterial infections and there is consequently considerable misuse and overuse of antibiotics among patients with COPD. This poses a severe burden on healthcare resources such as increased risk of developing antibiotic resistance. The biomarker procalcitonin (PCT) displays specificity to distinguish bacterial inflammations from nonbacterial inflammations and may therefore help to rationalize antibiotic prescriptions...
April 2017: Omics: a Journal of Integrative Biology
https://www.readbyqxmd.com/read/28219190/-efficacy-and-safety-of-procalcitonin-guidance-in-reducing-the-duration-of-antibiotic-treatment-of-sepsis-patients
#8
X L Xu, F D Yan, J Q Yu, Q H Chen, H Lin, R Q Zheng
Objective: To assesse the efficacy and safety of procalcitonin-guided antibiotic treatment of sepsis patients in intensive care units (ICU). Methods: A prospective, randomised, controlled trial was gone in ICU of Northern Jiangsu People's Hospital.Between January 2013 and December 2015.One hundred and fifty-six patients assessed for eligibility were randomly assigned to the procalcitonin-guided group (PCT group, 79) or to regular antibiotic group (RAT group, 77). Patients who received antibiotics for presumed infection according to principle of antimicrobial usage...
February 7, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28149576/duration-of-antibiotic-therapy-in-the-intensive-care-unit
#9
REVIEW
Gabor Zilahi, Mary Aisling McMahon, Pedro Povoa, Ignacio Martin-Loeches
There are certain well defined clinical situations where prolonged therapy is beneficial, but prolonged duration of antibiotic therapy is associated with increased resistance, medicalising effects, high costs and adverse drug reactions. The best way to decrease antibiotic duration is both to stop antibiotics when not needed (sterile invasive cultures with clinical improvement), not to start antibiotics when not indicated (treating colonization) and keep the antibiotic course as short as possible. The optimal duration of antimicrobial treatment for ventilator-associated pneumonia (VAP) is unknown, however, there is a growing evidence that reduction in the length of antibiotic courses to 7-8 days can minimize the consequences of antibiotic overuse in critical care, including antibiotic resistance, adverse effects, collateral damage and costs...
December 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28143877/procalcitonin-to-guide-antibiotic-administration-in-copd-exacerbations-a-meta-analysis
#10
REVIEW
Alexander G Mathioudakis, Victoria Chatzimavridou-Grigoriadou, Alexandru Corlateanu, Jørgen Vestbo
Challenges in the differentiation of the aetiology of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have led to significant overuse of antibiotics. Serum procalcitonin, released in response to bacterial infections, but not viral infections, could possibly identify AECOPD requiring antibiotics. In this meta-analysis we assessed the clinical effectiveness of procalcitonin-based protocols to initiate or discontinue antibiotics in patients presenting with AECOPD.Based on a prospectively registered protocol, we reviewed the literature and selected randomised or quasi-randomised trials comparing procalcitonin-based protocols to initiate or discontinue antibiotics versus standard care in AECOPD...
January 2017: European Respiratory Review: An Official Journal of the European Respiratory Society
https://www.readbyqxmd.com/read/28114931/procalcitonin-guided-diagnosis-and-antibiotic-stewardship-revisited
#11
REVIEW
Ramon Sager, Alexander Kutz, Beat Mueller, Philipp Schuetz
Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i...
January 24, 2017: BMC Medicine
https://www.readbyqxmd.com/read/28024740/impact-of-procalcitonin-guided-therapy-for-hospitalized-community-acquired-pneumonia-on-reducing-antibiotic-consumption-and-costs-in-japan
#12
Akihiro Ito, Tadashi Ishida, Hironobu Tokumasu, Yasuyoshi Washio, Akio Yamazaki, Yuhei Ito, Hiromasa Tachibana
BACKGROUND AND OBJECTIVE: This study aimed to investigate the usefulness of procalcitonin-guided therapy in hospitalized community-acquired pneumonia patients to reduce antibiotic duration and costs without worsening prognosis. METHODS: 352 hospitalized community-acquired pneumonia patients in an observational cohort study in which procalcitonin was measured three times serially, on admission (Day 1) and 2-3 days (Day 3) and 6-8 days (Day 7) after admission, between October 2010 and February 2016 were reviewed retrospectively...
March 2017: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
https://www.readbyqxmd.com/read/27929242/community-acquired-pneumonia-in-adults-diagnosis-and-management
#13
Alexander Kaysin, Anthony J Viera
Community-acquired pneumonia is a leading cause of death. Risk factors include older age and medical comorbidities. Diagnosis is suggested by a history of cough, dyspnea, pleuritic pain, or acute functional or cognitive decline, with abnormal vital signs (e.g., fever, tachycardia) and lung examination findings. Diagnosis should be confirmed by chest radiography or ultrasonography. Validated prediction scores for pneumonia severity can guide the decision between outpatient and inpatient therapy. Using procalcitonin as a biomarker for severe infection may further assist with risk stratification...
November 1, 2016: American Family Physician
https://www.readbyqxmd.com/read/27734780/-is-procalcitonin-measurement-useful-in-managing-respiratory-tract-infections
#14
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
https://www.readbyqxmd.com/read/27486746/host-biomarkers-for-distinguishing-bacterial-from-non-bacterial-causes-of-acute-febrile-illness-a-comprehensive-review
#15
REVIEW
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
https://www.readbyqxmd.com/read/27382274/point-of-care-procalcitonin-test-to-reduce-antibiotic-exposure-in-patients-hospitalized-with-acute-exacerbation-of-copd
#16
RANDOMIZED CONTROLLED TRIAL
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
https://www.readbyqxmd.com/read/27328801/meta-analysis-and-systematic-review-of-procalcitonin-guided-treatment-in-acute-exacerbation-of-chronic-obstructive-pulmonary-disease
#17
REVIEW
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
https://www.readbyqxmd.com/read/27283067/procalcitonin-guided-antibiotic-treatment-in-critically-ill-patients
#18
REVIEW
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...
February 2017: Langenbeck's Archives of Surgery
https://www.readbyqxmd.com/read/27279801/implementation-of-a-procalcitonin-guided-algorithm-for-antibiotic-therapy-in-the-burn-intensive-care-unit
#19
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
https://www.readbyqxmd.com/read/27224474/neutrophil-cd64-as-a-marker-of-bacterial-infection-in-acute-exacerbations-of-chronic-obstructive-pulmonary-disease
#20
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
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