Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission—a randomized trial

Kristoffersen, Kristina B; Søgaard, Ole Schmeltz; Wejse, Christian; Black, F. T.; Greve, Thomas; Tarp, Britta; Storgaard, Merete; Sodemann, Morten

doi:10.1111/j.1469-0691.2009.02709.x

Cited by 119 publications

(78 citation statements)

References 23 publications

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“…An interesting finding of the study was that in the PCT group, high-risk patients (according to the PSI score) and patients with positive blood cultures had higher PCT concentrations compared with low-risk patients and patients without positive cultures, resulting in longer durations of antibiotic courses. Similar results for CAP patients were reported from a Swiss multicenter trial, 37 a Danish trial, 42 and 2 Chinese studies. 43,44 Based on these trials, a PCT level of 0.25 mg/L or greater strongly suggests that a bacterial CAP is likely and antibiotics should be started without delay.…”

Section: Can Pct Be Used To Guide Antibiotic Therapy For Patients Witsupporting

confidence: 90%

Procalcitonin

Schüetz

Leykum

2012

Hospital Medicine Clinics

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General considerations:1. Always use high-sensitivity assays for measurement of procalcitonin with a functional assay sensitivity in the range of 0.06 mg/L. 2. Procalcitonin cutoff threshold values depend on the clinical setting and the type of infection.Procalcitonin and initial management of respiratory infections:3. Results should always be interpreted in conjunction with the clinical setting and context; use procalcitonin results to complement, but not replace, your clinical judgment. 4. In low-risk patients (ie, patients with bronchitis, chronic obstructive pulmonary disease exacerbation, or upper respiratory tract infection), initial procalcitonin results can be for decision making regarding the need for antibiotics. 5. In high-risk patients (ie, intensive care unit [ICU]-level patients or patients with severe pneumonia), use procalcitonin for guiding duration of treatment rather than for initiation of therapy. 6. Never wait for initial procalcitonin results in clinically unstable and/or high-risk patients (eg, severe sepsis and need for ICU admission) to start antibiotic therapy. 7. Always check procalcitonin after 6 to 24 hours if initial antibiotics are withheld and patients do not show improvement as clinically expected. CONTINUED CONTINUEDProcalcitonin and duration of antibiotic treatment:8. In low-risk patients, antibiotics can be discontinued if patients show clinical improvement and procalcitonin levels drop to less than 0.1 mg/L or likely even less than 0.25 mg/L. 9. In high-risk patients in the ICU setting, antibiotics can be discontinued if patients show clinical improvement and procalcitonin drops to less than 0.5 mg/L, and/or if levels drop by at least 80% to 90% of peak values. 10. Procalcitonin levels that are not decreasing can be found in patients not responding to antibiotic therapy, and are thus associated with increased risk for adverse patient outcomes. BACKGROUND Definitions

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Section: Can Pct Be Used To Guide Antibiotic Therapy For Patients Witsupporting

confidence: 90%

Procalcitonin

Schüetz

Leykum

2012

Hospital Medicine Clinics

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“…Over the past decade, several studies aimed to define parameters that allow the distinction between bacterial and viral infections causing LRTI. The methods used included polymerase chain reaction (PCR), procalcitonin determination and other clinical information [8,9,10,11,12,13,14,15]. However, the information obtained by medical history, physical examination, routine laboratory parameters and chest radiography is not sufficient for a clear differential diagnosis of the cause of LRTI.…”

Section: Introductionmentioning

confidence: 99%

Single and Multiple Viral Infections in Lower Respiratory Tract Infection

Gencay¹,

Roth²,

Müeller

et al. 2010

Respiration

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Background: Lower respiratory tract infection (LRTI) often leads to hospitalization, and it was indicated that causative viral infections are underestimated. Objectives: It was our aim to compare the frequency of 8 relevant viruses in 109 hospitalized LRTI patients and 144 healthy controls. Methods: Virus infection was determined by seroconversion and ELISA for anti-virus antibodies in repeated serum samples. Bacterial infection was diagnosed in respiratory specimens, blood cultures and urine. Results: The LRTI patient cohort consisted of 49 patients with community-acquired pneumonia, 30 patients with acute bronchitis and 30 chronic obstructive pulmonary disease patients with acute exacerbation. Viral infection was detected in 89 (82%) LRTI patients compared with 32 (22%) in healthy controls (relative risk 3.42, 95% confidence interval 2.48–4.72; p < 0.0001). The most frequent viral pathogens were: influenza B (23%), adenovirus (16%) and parainfluenza virus 3 (12%). Importantly, infections with more than 1 virus were detected in 63% (n = 57) of LRTI patients with viral infection, which represents 52% of all LRTI patients. No multiple virus infection was detected in the healthy controls. Patients with community-acquired pneumonia were more often infected with adenovirus and respiratory syncytial virus as compared with the other LRTI patients (p = 0.046 and 0.0009, respectively). Conclusions: There is a high incidence of single and multiple viral infections in LRTI patients requiring hospitalization. The data indicate the need for regular virus diagnosis and the development of point of care tools that enables a fast diagnosis of the most common viruses and bacteria. The data also imply the need to consider antiviral therapy in positive LRTI cases.

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“…Allerdings k ö nnte diese Kostenersparnis aufgehoben werden durch die Kosten der PCT-Testung, da die Bestimmung von PCT insbesondere im Verlauf aufgrund der hohen Reagenzienkosten sehr teuer ist [42] . In zwei Studien bei Patienten mit akuten Atemwegsinfektion konnte zwar gezeigt werden, dass die Antibiosesteuerung mit ein bis zwei PCT-Messungen pro Patient [31] oder sogar nur mit einer einzigen Messung [43] m ö glich ist. Vor allem die neueren Studien weisen jedoch darauf hin, dass im Rahmen der Therapiesteuerung PCT-Verlaufsmessungen unerl ä sslich sind.…”

Section: Klinische Anwendung Der Pct-spiegel Infektionsmarkerunclassified

Wie verlässlich ist die Bestimmung von Procalcitonin als Entzündungsmarker auf Intensivstation?/How reliable is procalcitonin as an inflammatory marker?

Biller

Fae

Germann

et al. 2011

LaboratoriumsMedizin

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Zusammenfassung Die Rolle von Procalcitonin (PCT)-Plasmaspiegel bei kritisch kranken Patienten wurde in den vergangenen Jahren intensiv untersucht. Insbesondere zur Erkennung von Infektionen erwiesen sich PCT-Plasmaspiegel in vielen Fällen anderen klinischen und biochemischen Markern überlegen. Neuere Untersuchungen zeigen, dass mit Hilfe der PCT-Spiegel bei bestimmten Erkrankungen die antibiotische Therapie gesteuert und damit der Antibiotika-Verbrauches reduziert werden kann. Für die Beurteilung der Prognose von kritisch kranken Intensivpatienten scheint der Parameter jedoch nur eingeschränkt verwertbar zu sein. Darüber hinaus können in seltenen Fällen falsch positive und falsch negative Werte auftreten. Trotz dieser Einschränkungen werden heutzutage PCT-Plasmaspiegel bereits vielfältig auf Intensivstationen eingesetzt. Die möglichen klinischen Anwendungen dieses Labormarkers als diagnostisches Werkzeug zur Beurteilung kritisch kranker Patienten sollen im Folgenden dargestellt werden.

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Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission—a randomized trial

Cited by 119 publications

References 23 publications

Procalcitonin

Procalcitonin

Single and Multiple Viral Infections in Lower Respiratory Tract Infection

Wie verlässlich ist die Bestimmung von Procalcitonin als Entzündungsmarker auf Intensivstation?/How reliable is procalcitonin as an inflammatory marker?

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