Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial

Montassier, Emmanuel; Javaudin, François; Moustafa, Farès; Nandjou, Demeno; Maignan, Maxime; Hardouin, Jean-Benoît; Annoot, Caroline; Ogielska, Maja; Orer, P.; Schotté, T.; Bouget, J.; Babaei, Syamak Agha; Raynal, Pierre-Alexis; Eche, Antoine; Duc, Albert Trinh; Cojocaru, R.; Benaouicha, Nesrine; Potel, G.; Batard, Éric; Talan, David A.

doi:10.1016/j.annemergmed.2019.02.025

Cited by 28 publications

(8 citation statements)

References 16 publications

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“…In addition, a systematic review found that PCT is better as a prognostic than as a diagnostic tool for CAP [ 64 ], and a recent meta-analysis reported that a PCT cutoff of 0.5 µg/L yielded low sensitivity and medium specificity, concluding that the biomarker should not be used to decide whether to initiate or discontinue antibiotic treatment [ 65 ]. These conclusions are further supported by more recent trials that failed to find a reduction of antibiotic use [ 51 , 66 ], and one study reported PCT to be outperformed by CRP and IL-6 regarding diagnostic accuracy for pneumonia in patients presenting with dyspnea [ 67 ]. These differing results may be explained by several factors, including low adherence and lower exposure in the control group due to changes in clinical practice, such as the establishment of short-course therapy [ 68 ].…”

Section: Medical Wardmentioning

confidence: 71%

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

Wolfisberg

Gregoriano

Schuetz

2021

Critical Reviews in Clinical Laboratory Sciences

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Procalcitonin (PCT) is useful for differentiating between viral and bacterial infections and for reducing the unnecessary use of antibiotics. As the rise of antimicrobial resistance reaches “alarming” levels according to the World Health Organization, the importance of using biomarkers, such as PCT to limit unnecessary antibiotic exposure has further increased. Randomized trials in patients with respiratory tract infections have shown that PCT has prognostic implications and its use, embedded in stewardship protocols, leads to reductions in the use of antibiotics in different clinical settings without compromising clinical outcomes. However, available data are heterogeneous and recent trials found no significant benefit. Still, from these trials, we have learned several key considerations for the optimal use of PCT, which depend on the clinical setting, severity of presentation, and pretest probability for bacterial infection. For patients with respiratory infections and sepsis, PCT can be used to determine whether to initiate antimicrobial therapy in low-risk settings and, together with clinical data, whether to discontinue antimicrobial therapy in certain high-risk settings. There is also increasing evidence regarding PCT-guided therapy in patients with coronavirus disease 2019 (COVID-19). This review provides an up-to-date overview of the use of PCT in different clinical settings and diseases, including a discussion about its potential to improve the care of patients with COVID-19.

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Section: Medical Wardmentioning

confidence: 71%

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

Wolfisberg

Gregoriano

Schuetz

2021

Critical Reviews in Clinical Laboratory Sciences

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“…Early studies suggested that procalcitonin may be a useful tool in this setting, but a recent randomized trial evaluating the impact of procalcitonin testing versus usual care on antibiotic utilization for patients presenting to the emergency department with possible lower respiratory tract infections reported no difference in antibiotic utilization. [26][27][28] Others have proposed that integrating procalcitonin testing with viral assays may be more helpful: the combination of a positive viral test and low procalcitonin may be more reassuring than either assay alone. 29,30 C-reactive protein testing may also help identify patients that can be safely managed without antibacterial treatment.…”

Section: Discussionmentioning

confidence: 99%

Respiratory viral testing and antibacterial treatment in patients hospitalized with community-acquired pneumonia

Imrey

Rhee

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: Viruses are more common than bacteria in patients hospitalized with community-acquired pneumonia. Little is known, however, about the frequency of respiratory viral testing and its associations with antimicrobial utilization. Design: Retrospective cohort study. Setting: The study included 179 US hospitals. Patients: Adults admitted with pneumonia between July 2010 and June 2015. Methods: We assessed the frequency of respiratory virus testing and compared antimicrobial utilization, mortality, length of stay, and costs between tested versus untested patients, and between virus-positive versus virus-negative patients. Results: Among 166,273 patients with pneumonia on admission, 40,787 patients (24.5%) were tested for respiratory viruses, 94.8% were tested for influenza, and 20.7% were tested for other viruses. Viral assays were positive in 5,133 of 40,787 tested patients (12.6%), typically for influenza and rhinovirus. Tested patients were younger and had fewer comorbidities than untested patients, but patients with positive viral assays were older and had more comorbidities than those with negative assays. Blood cultures were positive for bacterial pathogens in 2.7% of patients with positive viral assays versus 5.3% of patients with negative viral tests (P < .001). Antibacterial courses were shorter for virus-positive versus -negative patients overall (mean 5.5 vs 6.4 days; P < .001) but varied by bacterial testing: 8.1 versus 8.0 days (P = .60) if bacterial tests were positive; 5.3 versus 6.1 days (P < .001) if bacterial tests were negative; and 3.3 versus 5.2 days (P < .001) if bacterial tests were not obtained (interaction P < .001). Conclusions: A minority of patients hospitalized with pneumonia were tested for respiratory viruses; only a fraction of potential viral pathogens were assayed; and patients with positive viral tests often received long antibacterial courses.

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“…PCT has been proposed to reduce the use of antibiotics and their duration [58,59]. Nevertheless, the last available studies have not shown that the determination of PCT involves a reduction in antibiotic consumption [60,61].…”

Section: Procalcitoninmentioning

confidence: 99%

Biomarkers in Community-Acquired Pneumonia (Cardiac and Non-Cardiac)

Méndez

Aldás

Menéndez

2020

JCM

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Community-acquired pneumonia (CAP) remains the first cause of morbidity and mortality worldwide due to infection. Several aspects such as severity and host response are related to its clinical course and outcome. Beyond the acute implications that the infection provokes in the host, pneumonia also has long-term negative consequences. Among them, cardiovascular complications and mortality are the most outstanding. Therefore, an adequate recognition and stratification of the risk of complications and mortality is crucial. Many biomarkers have been studied for these reasons, considering that each biomarker mirrors a different aspect. Moreover, the clinical application of many of them is still being deliberated because of their limitations and the heterogeneity of the disease. In this review, we examine some of the most relevant biomarkers that we have classified as cardiac and non-cardiac. We discuss some classic biomarkers and others that are considered novel biomarkers, which are mainly involved in cardiovascular risk.

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Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial

Cited by 28 publications

References 16 publications

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

Respiratory viral testing and antibacterial treatment in patients hospitalized with community-acquired pneumonia

Biomarkers in Community-Acquired Pneumonia (Cardiac and Non-Cardiac)

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