Clinical and economic impact of procalcitonin to shorten antimicrobial therapy in septic patients with proven bacterial infection in an intensive care setting

Deliberato, Rodrigo Octávio; Marra, Alexandre R.; Sanches, Paula Rodrigues; Martino, Marinês Dalla Valle; Ferreira, Carlos Eduardo dos Santos; Pasternak, Jacyr; Paes, Ângela Tavares; Pinto, Lilian Moreira; Santos, Oscar Fernando Pavão dos; Edmond, Michael B.

doi:10.1016/j.diagmicrobio.2013.03.027

Cited by 79 publications

(85 citation statements)

References 26 publications

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“…We referred to 9 RCT reports during our meta‐analysis on this topic 78, 79, 80, 81, 82, 83, 84, 85, 86. No significant differences were observed between the intervention and control groups with respect to ICU stay time, hospitalization period, 60‐day mortality rate, and 90‐day mortality rate.…”

Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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“…This model builds on previous procalcitonin cost-effectiveness models, including studies of its use in lower respiratory tract infection and on Canadian and Brazilian analyses that considered more limited variables in the sepsis setting. [15][16][17][18] Our analysis aims to provide decision makers further information to consider when evaluating the use of procalcitonin in their health systems.…”

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confidence: 99%

Is Procalcitonin-Guided Antimicrobial Use Cost-Effective in Adult Patients with Suspected Bacterial Infection and Sepsis?

Harrison

Collins

2015

Infect. Control Hosp. Epidemiol.

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“…Deliberato et al (41) tested the clinical and economic impact of a PCT algorithm to shorten antibiotic therapy in critical care septic patients. In the per-protocol analysis they found a significant reduction of duration of antibiotic therapy (median days: 9, 5-24 in PCT group versus 13, 3-45, Westwood et al (49) assessed clinical and costeffectiveness of PCT testing to guide antibiotic therapy in patients with sepsis in ICU and emergency departments.…”

Section: Cost-effectivenessmentioning

confidence: 99%

Biomarker-guided antibiotic therapy—strengths and limitations

et al. 2017

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Biomarkers as C-reactive protein (CRP) and procalcitonin (PCT) emerged as tools to help clinicians to diagnose infection and to properly initiate and define the duration of antibiotic therapy. Several randomized controlled trials, including adult critically ill patients, showed that PCT-guided antibiotic stewardship was repeatedly associated with a decrease in the duration of antibiotic therapy with no apparent harm. There are however some relevant limitations in these trials namely the low rate of compliance of PCTguided algorithms, the high rate of exclusion (without including common clinical situations and pathogens) and the long duration of antibiotic therapy in control groups. Such limitations weakened the real impact of such algorithms in the clinical decision-making process and strengthened the concept that the initiation and the duration of antibiotic therapy cannot depend solely on a biomarker. Future efforts should address these limitations in order to better clarify the role of biomarkers on the complex and multifactorial issue of antibiotic management and to deeply understand its potential effect on mortality.

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Clinical and economic impact of procalcitonin to shorten antimicrobial therapy in septic patients with proven bacterial infection in an intensive care setting

Cited by 79 publications

References 26 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Is Procalcitonin-Guided Antimicrobial Use Cost-Effective in Adult Patients with Suspected Bacterial Infection and Sepsis?

Biomarker-guided antibiotic therapy—strengths and limitations

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