Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial

Christ‐Crain, Mirjam; Jaccard-Stolz, Daiana; Bingisser, Roland; Gencay, Mikael; Huber, Peter; Tamm, Michael; Müller, Beat

doi:10.1016/s0140-6736(04)15591-8

Cited by 989 publications

(799 citation statements)

References 34 publications

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“…In this study, PCT at a low cutoff of 0.1 ng/ml was an early and accurate laboratory parameter to distinguish BSI from blood contamination due to coagulase-negative staphylococci, which was superior to the accuracy of CRP. These findings are consistent with other reports in comparable settings, showing that PCT is a more reliable parameter for distinguishing infectious from non-infectious febrile episodes and for initiation and guidance of antimicrobial treatment [5][6][7][8]15]. Our findings also underline the importance of the use of more sensitive PCT assays to appreciate its full diagnostic potential [16].…”

Section: Discussionsupporting

confidence: 92%

“…Serum procalcitonin (PCT) has emerged as a biomarker for diagnosis of various bacterial infections and was found to have higher diagnostic accuracy as compared to clinical characteristics or commonly used laboratory parameters, such as white blood count (WBC) and serum C-reactive protein (CRP) [5][6][7][8][9]. However, the diagnostic accuracy of PCT to distinguish blood culture contamination from BSI is not known.…”

Section: Introductionmentioning

confidence: 99%

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Serum Procalcitonin for Discrimination of Blood Contamination from Bloodstream Infection due to Coagulase-Negative Staphylococci

2007

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The diagnostic value of serum procalcitonin (PCT) to distinguish blood contamination from bloodstream infection (BSI) due to coagulase-negative staphylococci was evaluated. Patients with BSI had higher PCT concentration than those with blood contamination at day -1, day 0 and day +1 with regard to blood culture collection (p < 0.05), whereas serum Creactive protein values were significantly higher only on day +1. At a cutoff of 0.1 ng/dl, PCT had a sensitivity of 86% and 100%, and a specificity of 60% and 80% for the diagnosis of BSI on day -1 and 0, respectively. In addition to clinical and microbiological parameters, PCT may help discriminating blood contamination from BSI due coagulase-negative staphylococci.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Serum Procalcitonin for Discrimination of Blood Contamination from Bloodstream Infection due to Coagulase-Negative Staphylococci

2007

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“…The design of the two trials was similar and a complete description has been reported in detail elsewhere [18,19]. In brief, the first trial included 243 consecutive patients with clinically suspected lower respiratory tract infections including acute and exacerbation of chronic bronchitis, and CAP, admitted from December 2002 until April 2003.…”

Section: Study Samplementioning

confidence: 99%

Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings

et al. 2008

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SUMMARYIn patients with community-acquired pneumonia (CAP) prediction rules based on individual predicted mortalities are frequently used to support decision-making for in-patient vs. outpatient management. We studied the accuracy and the need for recalibration of three risk prediction scores in a tertiary-care University hospital emergency-department setting in Switzerland. We pooled data from patients with CAP enrolled in two randomized controlled trials. We compared expected mortality from the original pneumonia severity index (PSI), CURB65 and CRB65 scores against observed mortality (calibration) and recalibrated the scores by fitting the intercept a and the calibration slope b from our calibration model. Each of the original models underestimated the observed 30-day mortality of 11 %, in 371 patients admitted to the emergency department with CAP (8 . 4%, 5 . 5 % and 5 . 0% for the PSI, CURB65 and CRB65 scores, respectively). In particular, we observed a relevant mortality within the low risk classes of the original models (2 . 6%, 5 . 3%, and 3 . 7% for PSI classes I-III, CURB65 classes 0-1, and CRB65 class 0, respectively). Recalibration of the original risk models corrected the miscalibration. After recalibration, however, only PSI class I was sensitive enough to identify patients with a low risk (i.e. <1%) for mortality suitable for outpatient management. In our tertiary-care setting with mostly referred in-patients, CAP risk scores substantially underestimated observed mortalities misclassifying patients with relevant risks of death suitable for outpatient management. Prior to the implementation of CAP risk scores in the clinical setting, the need for recalibration and the accuracy of low-risk re-classification should be studied in order to adhere with discharge guidelines and guarantee patients' safety.

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“…Respiratory tract infections contribute significantly to the problem of antibiotic misuse. Approximately 75% of all antibiotics prescribed in the ambulatory setting are for acute respiratory tract (ARI) infections, and albeit their use is associated with a significant symptomatic effect, their use is inappropriate because the vast majority of these infections are viral [2]. In addition, clinical and microbiological evaluations are neither sensitive nor specific to differentiate bacterial from viral respiratory tract infections [3], and thus of limited value for directing therapy.…”

mentioning

confidence: 99%

“…Among the several biomarkers that have been identified and proposed, procalcitonin (PCT), a calcitonin precursor hormone, is probably the most promising one. Guidance about serum PCT concentration has substantially reduced antibiotic use in patients presenting at the emergency department (ED) or admitted to hospital for lower respiratory tract infections [2,4,5]. In a meta-analysis including 14 trials including 4221 patients, the use of PCT to guide initiation and duration of antibiotic treatment in patients with ARIs was found to be effective: antibiotic consumption was significantly reduced across different clinical settings and ARI diagnoses, while its use was not associated with higher mortality rates or treatment failure [6].…”

mentioning

confidence: 99%

Procalcitonin-guided antibiotic therapy: a potentially effective and efficient strategy

Plebani

Fabbri

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial

Cited by 989 publications

References 34 publications

Serum Procalcitonin for Discrimination of Blood Contamination from Bloodstream Infection due to Coagulase-Negative Staphylococci

Serum Procalcitonin for Discrimination of Blood Contamination from Bloodstream Infection due to Coagulase-Negative Staphylococci

Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings

Procalcitonin-guided antibiotic therapy: a potentially effective and efficient strategy

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