Effectiveness of a procalcitonin algorithm to guide antibiotic therapy in respiratory tract infections outside of study conditions: a post-study survey

Abstract

All published evidence on procalcitonin (PCT)-guided antibiotic therapy was obtained in trials where physicians knew that they were being monitored, possibly resulting in higher adherence to the PCT algorithm. This study investigates the effectiveness of PCT guidance in an observational quality control survey. We monitored antibiotic therapy and algorithm adherence in consecutive patients with respiratory tract infections admitted to the Kantonsspital Aarau, Switzerland, between May 2008 and February 2009. The results were compared to the site-specific results of the former ProHOSP study. Overall and more pronounced for patients with community-acquired pneumonia, the median duration of antibiotic treatment in this survey was shorter than the ProHOSP control patients (6 vs. 7 days, P = 0.048 and 7 vs. 9 days, P < 0.001). In 72.5% of patients, antibiotics were administered according to the prespecified PCT algorithm. No significant differences concerning adverse medical outcome could be detected. This study mirrors the use of PCT-guided antibiotic therapy in clinical practice, outside of trial conditions. If algorithm adherence is reinforced, antibiotic exposure can be markedly reduced with subsequent reduction of antibiotic-associated side effects and antibiotic resistance. The integration of the PCT algorithm into daily practice requires ongoing reinforcement and involves a learning process of the prescribing physicians.

The real life application of a procalcitonin-based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia: a proof of concept

“…This result is likely due to the limited number of patients included in the study, and in general the impact of a PCT-based algorithm on the hospital stay in CAP is not yet known as shown in other studies, where the in-hospital length of stay was similar in the active group and controls. 10,13 Our results along with those of the above cited studies are appealing, and the way to minimize antibiotic treatment duration without affecting safety, may be an important issue to reduce hospital stay and costs.…”

“…This was an international, multicenter observational quality survey that showed a significant reduction in antibiotic exposure in the PCT group compared to the control group [5.9 vs 7.4 days; difference, -1.51 days; 95% confidence interval (CI), -2.04 to -0.98; P<0.001], with no risk increase in the combined adverse outcome end point within 30 days of followup when the PCT algorithm was followed regarding early cessation of antibiotics (adjusted odds ratio, 0.61; 95% CI, 0.36 to 1.04; P=0.07). 10 However, the population studied was heterogeneous with a prevalence of nearly 30% of acute bronchitis and acute exacerbations of chronic obstructive pulmonary disease, which are lower respiratory tract infections far less severe than CAP in hospitalized patients. Furthermore, disease severity assessed by CURB-65 in CAP patients in the study, was less than in a population of real-life CAP patients commonly observed and cared in medical wards (mean/median 1.1/0 vs 1.8/2 in our population).…”

“…The adherence to the algorithm in CAP patients is reported between 35 and 80% in the real-life context of the proREAL study. 10 This depends on factors such as the experience with PCT guided management strategies and PCT culture overall. In experienced centers the overall algorithm compliance has been of 90% outside of study conditions in hospital well used to the algorithm.…”

Novel Biomarkers to Detect Infection in Revision Hip and Knee Arthroplasties

“…It reaches its peak after 6 hours and has a half-life of 25 to 30 hours [13,23]. Some studies have shown the course of procalcitonin serum levels reflects the success of antibiotic treatment of bacterial infection rapidly, closely, and more reliably than CRP level [13,18,29,31,37].…”

Procalcitonin Kinetics and Nosocomial Pneumonia in Older Patients

“…Previous studies [9][10][11] have indicated that procalcitonin is superior to other commonly used parameters in its specificity for bacterial infection and might help to guide antibiotic stewardship in lower respiratory tract infections. However, its role in critically ill patients is still disputed.…”