Effectiveness and Safety of Procalcitonin-Guided Antibiotic Therapy in Lower Respiratory Tract Infections in “Real Life”

Albrich, Werner C.; Dusemund, Frank; Bucher, Birgit; Meyer, Stefan; Thomann, Robert V.; Kuhn, Félix P.; Bassetti, Stefano; Sprenger, Martin; Bächli, Esther; Sigrist, Thomas; Schwietert, M; Amin, Devendra; Hausfater, Pierre; Carre, Eric; Gaillat, J.; Schuetz, Philipp; Regez, Katharina; Bossart, Rita; Schild, Ursula; Müeller, Beat

doi:10.1001/archinternmed.2012.770

Cited by 136 publications

(49 citation statements)

References 39 publications

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“…In a computer-based model, retrospective data analysis from 1,312 ICU patients and an arbitrary use of PCT-algorithm showed substantial reduction in the treatment costs, based on the German DRG system (DRG, diagnosis related groups, a system of disease related reimbursement) [56]. Two minor studies in France did not see a beneficial effect of PCT based algorithm, but others confirmed the significant reduction of antibiotic use in the clinical routine as well [57, 58]. Further studies are under way, e.g.…”

Section: Possible Side Effectsmentioning

confidence: 99%

Update on Procalcitonin Measurements

2014

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Procalcitonin (PCT) is used as a biomarker for the diagnosis of sepsis, severe sepsis and septic shock. At the same time, PCT has also been used to guide antibiotic therapy. This review outlines the main indications for PCT measurement and points out possible pitfalls. The classic indications for PCT measurement are: (i) confirmation or exclusion of diagnosis of sepsis, severe sepsis, or septic shock, (ii) severity assessment and follow up of systemic inflammation mainly induced by microbial infection, and (iii) individual, patient adapted guide of antibiotic therapy and focus treatment. Using serially monitored PCT levels, the duration and need of antibiotic therapy can be better adapted to the individual requirements of the patient. This individualized approach has been evaluated in various studies, and it is recommended to be a part of an antibiotic stewardship program.

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Section: Possible Side Effectsmentioning

confidence: 99%

Update on Procalcitonin Measurements

2014

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“…In a prospective, observational, international, multicenter, quality control survey (ProREAL) (1759 patients) of PCT-guided antibiotic therapy for lower respiratory tract infection, the duration of antibiotic therapy was significantly shortened if the algorithm of PCT was followed. The mean overall reduction was approximately 20 % (from 7.4 to 5.9 days) [4].Other previous randomized controlled trials have suggested that using clinical algorithms based on PCT results in reduced antibiotic use without a deleterious effect on clinical outcomes. These results have been supported by strong evidence in respiratory infections, and the studies reported approximately 20-50 % reduction in antibiotic usage in patients with lower respiratory tract infection [4-6, 54, 55].…”

Section: Pct-guided Antibiotics Strategymentioning

confidence: 75%

“…Procalcitonin (PCT) is widely used to differentiate bacterial infections from non-bacterial infections or other inflammatory conditions, and growing evidences has suggested that PCT reliably differentiates sepsis from SIRS. Moreover, it has been recently shown that PCT is a valuable tool to guide antibiotic treatment in patients with bacterial infections [2][3][4][5][6].The aim of this review is to summarize the current evidence for PCT in different infections and clinical settings, and discuss the strengths and limitations of PCT.…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin: present and future

et al. 2015

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Critically ill patients are frequently at risk of sepsis or inflammatory conditions. Procalcitonin (PCT) is a biomarker for critically ill patients to differentiate sepsis from non-infectious triggers of the systemic inflammatory response syndrome. It has been recently shown that PCT is a valuable tool to guide antibiotic treatment in patients with bacteria infections. However, PCT is also less than a universal and perfect biomarker, and its physiologic role remains unknown. An increase in PCT is associated not only with localized bacterial infection, but also with non-infectious disease or other microbial infections. Numerous studies have suggested that use of PCT would reduce patients' exposure to antibiotics; however, the use of PCT-guided management of antibiotics strategy needs further study to validate their safety in daily practice in ICU settings. Data supporting this concept from randomized trials are still required. Future studies should focus on PCT kinetics. On the other hand, the need for biologic role of PCT shall be highlighted. Immunoneutralization of PCT will likely be a therapeutic approach for human sepsis only if its physiologic effects are elaborated. The aim of this review is to summarize and discuss the current evidence for PCT in a series of clinical settings.

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“…Unfortunately, robust clinical data on this topic are still scarce. Two publications in respiratory tract infections in the outpatient setting could show a sigificant reduction of antibiotic use if a PCT-guided algorithm was employed [37,38]. In septic intensive care patients, a retrospective study demonstrated that implementation of a PCT-based algorithm was associated with a significantly shortened length of antibiotic treatment over a 5-year observation period [10].…”

Section: Discussionmentioning

confidence: 99%