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Procalcitonin use real world decisions

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17 papers 500 to 1000 followers
By Jason Mann No BS pulmonary critical care fellow
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
Andre C Kalil, Trevor C Van Schooneveld
No abstract text is available yet for this article.
May 2018: Critical Care Medicine
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
Domonkos Trásy, Zsolt Molnár
Sepsis is one of the biggest challenges in critical care nowadays. Defining sepsis is a difficult task on its own and its diagnosis and treatment requires well trained, devoted personnel with interdisciplinary collaboration in order to provide the patients the best chance for survival. Immediate resuscitation, early adequate antimicrobial therapy, source control and highly sophisticated organ support on the intensive care units are all inevitable necessities for successful recovery. To help fast and accurate diagnosis biomarkers have been measured for decades...
May 2017: EJIFCC
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
Jason Mann, Rodrigo Cavallazzi
The objective of this study was to present a case report that highlights the limitation of serum procalcitonin levels greater than 10 ng/mL as being almost exclusively secondary to septic shock. Data source was a medical intensive care unit patient at the University of Louisville. Anaphylactic shock may cause elevations of serum procalcitonin to levels greater than 10 ng/mL.
January 2015: American Journal of Emergency Medicine
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
María Heredia-Rodríguez, Juan Bustamante-Munguira, Inmaculada Fierro, Mario Lorenzo, Pablo Jorge-Monjas, Esther Gómez-Sánchez, Francisco J Álvarez, Sergio D Bergese, José María Eiros, Jesús F Bermejo-Martin, José I Gómez-Herreras, Eduardo Tamayo
PURPOSE: We intended to assess how acute kidney injuy impacts on procalcitonin levels in cardiac surgery patients, with or without infection, and whether procalcitonin might be used as a biomarker of infection in acute kidney injuy. MATERIAL AND METHODS: A case-control study was designed which included patients that had had cardiac surgery between January 2011 and January 2015. Every patient developing severe sepsis or septic shock (n = 122; 5.5%) was enrolled. In addition, consecutive cardiac surgery patients during 2013 developing systemic inflammatory response syndrome (n = 318) were enrolled...
June 2016: Journal of Critical Care
Emilio Maseda, Alejandro Suarez-de-la-Rica, Víctor Anillo, Eduardo Tamayo, Carlos A García-Bernedo, Fernando Ramasco, Maria-Jose Villagran, Genaro Maggi, Maria-Jose Gimenez, Lorenzo Aguilar, Juan-José Granizo, Antonio Buño, Fernando Gilsanz
PURPOSE: Because procalcitonin (PCT) might be surrogate for antimicrobial discontinuation in general intensive care units (ICUs), this study explored its use for secondary peritonitis in 4 surgical ICUs (SICUs). METHODS: A retrospective study including all consecutive patients with secondary peritonitis, controlled infection source, requiring surgery, and at least 48-hour SICU admission was performed (June 2012-June 2013). Patients were divided following notations in medical records into PCT-guided (notation of PCT-based antibiotic discontinuation) and non-PCT-guided (no notation) groups...
June 2015: Journal of Critical Care
Werner C Albrich, Frank Dusemund, Birgit Bucher, Stefan Meyer, Robert Thomann, Felix Kühn, Stefano Bassetti, Martin Sprenger, Esther Bachli, Thomas Sigrist, Martin Schwietert, Devendra Amin, Pierre Hausfater, Eric Carre, Jacques Gaillat, Philipp Schuetz, Katharina Regez, Rita Bossart, Ursula Schild, Beat Mueller
BACKGROUND: In controlled studies, procalcitonin (PCT) has safely and effectively reduced antibiotic drug use for lower respiratory tract infections (LRTIs). However, controlled trial data may not reflect real life. METHODS: We performed an observational quality surveillance in 14 centers in Switzerland, France, and the United States. Consecutive adults with LRTI presenting to emergency departments or outpatient offices were enrolled and registered on a website, which provided a previously published PCT algorithm for antibiotic guidance...
May 14, 2012: Archives of Internal Medicine
Noel S Lee, Lori B Daniels
Sorting out the etiology of dyspnea in patients with a history of heart failure is not always straightforward. Although an acute heart failure exacerbation would seem to be easy to distinguish from an acute respiratory illness, data from objective clinical studies has shown otherwise. Procalcitonin (PCT), a biomarker that rises in the setting of bacterial infection, carries great potential for guiding the diagnosis and treatment of heart failure patients with possible acute respiratory infection. In this issue of the International Journal of Cardiology, Kutz et al...
September 20, 2014: International Journal of Cardiology
Yahya Shehabi, Martin Sterba, Peter Maxwell Garrett, Kanaka Sundaram Rachakonda, Dianne Stephens, Peter Harrigan, Alison Walker, Michael J Bailey, Bronwyn Johnson, David Millis, Geoff Ding, Sandra Peake, Helen Wong, Jane Thomas, Kate Smith, Loretta Forbes, Miranda Hardie, Sharon Micallef, John F Fraser
RATIONALE: The role of procalcitonin (PCT), a widely used sepsis biomarker, in critically ill patients with sepsis is undetermined. OBJECTIVES: To investigate the effect of a low PCT cut-off on antibiotic prescription and to describe the relationships between PCT plasma concentration and sepsis severity and mortality. METHODS: This was a multicenter (11 Australian intensive care units [ICUs]), prospective, single-blind, randomized controlled trial involving 400 patients with suspected bacterial infection/sepsis and expected to receive antibiotics and stay in ICU longer than 24 hours...
November 15, 2014: American Journal of Respiratory and Critical Care Medicine
Kenneth L Becker, Richard Snider, Eric S Nylen
OBJECTIVE: The use of procalcitonin (ProCT) as a marker of several clinical conditions, in particular, systemic inflammation, infection, and sepsis, will be clarified, and its current limitations will be delineated. In particular, the need for a more sensitive assay will be emphasized. For these purposes, the medical literature comprising clinical studies pertaining to the measurement of serum ProCT in various clinical settings was examined. DATA SOURCE AND SELECTION: A PubMed search (1965 through November 2007) was conducted, including manual cross-referencing...
March 2008: Critical Care Medicine
Benjamin M P Tang, Guy D Eslick, Jonathan C Craig, Anthony S McLean
Procalcitonin is widely reported as a useful biochemical marker to differentiate sepsis from other non-infectious causes of systemic inflammatory response syndrome. In this systematic review, we estimated the diagnostic accuracy of procalcitonin in sepsis diagnosis in critically ill patients. 18 studies were included in the review. Overall, the diagnostic performance of procalcitonin was low, with mean values of both sensitivity and specificity being 71% (95% CI 67-76) and an area under the summary receiver operator characteristic curve of 0...
March 2007: Lancet Infectious Diseases
Steven C Reynolds, Andrew F Shorr, John Muscedere, Xuran Jiang, Daren K Heyland
OBJECTIVE: The utility of procalcitonin for the diagnosis of infection in the critical care setting has been extensively investigated with conflicting results. Herein, we report procalcitonin values relative to baseline patient characteristics, presence of shock, intensive care unit time course, infectious status, and Gram stain of infecting organism. DESIGN: Prospective, multicenter, observational study of critically ill patients admitted to intensive care unit for >24 hrs...
October 2012: Critical Care Medicine
Nathalie Layios, Bernard Lambermont, Jean-Luc Canivet, Philippe Morimont, Jean-Charles Preiser, Christophe Garweg, Didier Ledoux, Frédéric Frippiat, Sonia Piret, Jean-Baptiste Giot, Patricia Wiesen, Christelle Meuris, Paul Massion, Philippe Leonard, Monique Nys, Patrizio Lancellotti, Jean-Paul Chapelle, Pierre Damas
OBJECTIVES: To test the usefulness of procalcitonin serum level for the reduction of antibiotic consumption in intensive care unit patients. DESIGN: Single-center, prospective, randomized controlled study. SETTING: Five intensive care units from a tertiary teaching hospital. PATIENTS: All consecutive adult patients hospitalized for >48 hrs in the intensive care unit during a 9-month period. INTERVENTIONS: Procalcitonin serum level was obtained for all consecutive patients suspected of developing infection either on admission or during intensive care unit stay...
August 2012: Critical Care Medicine
Jean-Pierre Quenot, Charles-Edouard Luyt, Nicolas Roche, Martin Chalumeau, Pierre-Emmanuel Charles, Yann-Eric Claessens, Sigismond Lasocki, Jean-Pierre Bedos, Yves Péan, François Philippart, Stéphanie Ruiz, Christele Gras-Leguen, Anne-Marie Dupuy, Jérôme Pugin, Jean-Paul Stahl, Benoit Misset, Rémy Gauzit, Christian Brun-Buisson
Biomarker-guided initiation of antibiotic therapy has been studied in four conditions: acute pancreatitis, lower respiratory tract infection (LRTI), meningitis, and sepsis in the ICU. In pancreatitis with suspected infected necrosis, initiating antibiotics best relies on fine-needle aspiration and demonstration of infected material. We suggest that PCT be measured to help predict infection; however, available data are insufficient to decide on initiating antibiotics based on PCT levels. In adult patients suspected of community-acquired LRTI, we suggest withholding antibiotic therapy when the serum PCT level is low (<0...
July 8, 2013: Annals of Intensive Care
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