Impact of Procalcitonin Guidance with an Educational Program on Management of Adults Hospitalized with Pneumonia

Walsh, Thomas; DiSilvio, Briana; Hammer, Crystal; Beg, Moeezullah; Vishwanathan, Swati; Speredelozzi, Daniel; Moffa, Matthew; Hu, Kurt; Abdulmassih, Rasha; Makadia, Jina; Sandhu, Rikinder; Naddour, Mouhib; Chan-Tompkins, Noreen H.; Trienski, Tamara L.; Watson, Courtney; Obringer, Terrence J.; Kuzyck, Jim; Bremmer, Derek N.

doi:10.1016/j.amjmed.2017.08.039

Cited by 22 publications

(17 citation statements)

References 27 publications

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“…Procalcitonin (PCT), as a calcitonin precursor, is involved in the systemic reaction induced by the circulating endotoxins and inflammatory cytokines 4,5 . Several studies showed PCT serum level is significantly higher in patients with bacterial infections, such as pneumonia, than in those with viral infections and non-infectious diseases and is used as a diagnostic marker for bacterial infections 6 .…”

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confidence: 99%

The role of procalcitonin in differential diagnosis between acute radiation pneumonitis and bacterial pneumonia in lung cancer patients receiving thoracic radiotherapy

Wang

Huo

et al. 2020

Sci Rep

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Acute Radiation Pneumonitis (ARP) is one of the most common dose-limiting toxicities of thoracic radiotherapy. The accurate diagnosis of ARP remains a challenge because of the lack of a rapid biomarker capable of differentiating ARP from bacterial pneumo (BP). The aim of this study was to investigate the potential usefulness of procalcitonin (PCT) in the differential diagnosis of ARP and BP. Lung cancer patients who had undergone thoracic radiotherapy within 6 months and were admitted to hospital for ARP or BP were retrospectively analyzed. The serum levels of PCT, C-reactive protein (CRP) and white blood cells (WBC) were compared between the two groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic value of PCT, CRP and WBC in the differential diagnosis of ARP and BP and determine the best cutoff values. One hundred eighteen patients were included. Among them, seventy-seven patients were diagnosed with ARP, and 41 patients were diagnosed with BP. The PCT concentrations for patients diagnosed with ARP group were significantly lower than those in the BP group (P < 0.001). There were no differences in CRP and WBC between the two groups. The areas under the ROC curves (AUC) for PCT, CRP and WBC were 0.745, 0.589 and 0.578, respectively. The best cutoff values of PCT, CRP and WBC were 0.47 μg/L, 54.5 mg/L and 9.9 × 10 9 /L, respectively. Low serum PCT levels are associated with ARP. PCT is a useful biomarker to distinguish ARP from BP. Radiotherapy has been widely used for the curative and palliative treatment of lung cancer. Radiation-induced lung injury (RILI) is the most common dose-limiting toxicity of thoracic radiotherapy 1. RILI includes acute radiation pneumonitis (ARP) and pulmonary fibrosis. ARP often occurs about 1 to several months after radiotherapy. Commonly, ARP is relatively mild with patients, exhibiting no obvious symptoms except for imaging abnormalities. However, ARP can be a very serious event, especially after large volume radiotherapy. The incidence of grade 3-5 ARP can reach about 20% according to a recent study 2. When symptoms are more severe, patients cannot be managed as outpatients and require hospitalization. Continued progression of symptomatic ARP can cause respiratory failure and even death. Early and timely intervention can prevent the progression of ARP, improve patient symptoms, and potentially reduce post-radiation pulmonary fibrosis. However, accurate diagnosis of ARP remains difficult. The most important issue for radiation oncologists is to differentiate them from the bacterial pneumonia (BP) which are common in lung cancer patients 3. ARP and BP share many of the same symptoms such as cough and fever and both can be identified by changes in imaging. ARP can usually be identified by the positional relationship between the shapes of the radiation field and the

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confidence: 99%

The role of procalcitonin in differential diagnosis between acute radiation pneumonitis and bacterial pneumonia in lung cancer patients receiving thoracic radiotherapy

Wang

Huo

et al. 2020

Sci Rep

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“…Accordingly, other studies showed an improvement in the accuracy of diagnosis and severity assessment of community acquired pneumonia for the approaches using PCT. 46,52,53 Moreover, in the context of the diagnosis of pneumonia, contrary to the studies presented so far, Le Ben et al have shown evidence that PCT is not an adequate marker. In detail, the study in question is part of a subanalysis related to a prospective multicenter study that evaluates the role of thoracic CT in the diagnosis of pneumonia in a population of 200 patients.…”

Section: Procalcitonin For Diagnosis Of Bacterial Sepsismentioning

confidence: 91%

“…When procalcitonin was tested in specific clinical settings, such as populations of community-acquired pneumonia, to evaluate both the potential benefits of diagnostic speed and accuracy and optimize clinical management in lower respiratory tract infections, the authors have obtained conflicting results. [46][47][48] A relevant proposal has been provided by Muller et al, suggesting a different behavior of serum procalcitonin levels between bacterial rather than viral pneumonia.…”

Section: Procalcitonin For Diagnosis Of Bacterial Sepsismentioning

confidence: 98%

Procalcitonin in clinical practice: from diagnosis of sepsis to antibiotic therapy

2021

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A diagnostic algorithm that allows for the rapid identification of sepsis and possibly guides the appropriate antimicrobial therapy application is the cornerstone to obtaining effective treatment and better results. The use of emerging surrogate markers could significantly improve clinical practice, but the validity and clinical utility have been proved only for very few of them, and their availability in clinical routine is limited. For this purpose, numerous scientific evidence has indicated procalcitonin as a marker linked to sepsis and its evolution. This review aims to retrace the main evidence relating to the use of procalcitonin in sepsis. We analyzed the primary studies in the literature and the existing meta-analysis evaluating the behavior of procalcitonin as a marker of bacterial sepsis, its prognostic power, and its ability to influence antibiotic therapy. Recent evidence has suggested that procalcitonin could be an efficient marker for diagnosing sepsis and its therapeutic management in many types of patients. The choice of the appropriate timing to initiate and suspend antibiotic therapy, with obvious clinical advantages, the favorable effects could also include reducing health costs, both avoiding the administration of inappropriate antibiotic therapies, and reducing the duration of hospitalization. Moreover, limited studies reported high procalcitonin levels in coronavirus disease 2019 patients with a worse prognosis. Despite the considerable evidence in favor of the potential of procalcitonin as an index for managing septic patients, there are conflicting data that deserve specific and detailed studies.

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“…These study results were replicated in a pharmacist-driven study by Brock et al [11] in which use of PCT-guided algorithms was associated with reduced antibiotic days of therapy in a community hospital. Two subsequent studies evaluated PCT guidance in “real-world” settings and found that antibiotic duration and inpatient LOS were significantly shorter when a PCT-guided algorithm combined with education was implemented [12, 13].…”

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Impact of Procalcitonin Levels Combined with Active Intervention on Antimicrobial Stewardship in a Community Hospital

Newton

Robinson

Ling

et al. 2019

Open Forum Infectious Diseases

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BackgroundProcalcitonin (PCT) guidance alone or in conjunction with antibiotic stewardship programs (ASPs) has been shown to reduce antibiotic utilization and duration of therapy without adversely affecting patient outcomes.MethodsIn a community hospital, we investigated the impact of PCT with ASP recommendations on length of stay (LOS), length of antimicrobial therapy (LOT) after ASP recommendation, and total LOT over a 1-year period. Adult patients with at least 1 PCT value and concomitant ASP recommendations were included. Patients were grouped by provider ASP compliance and further stratified by normal versus elevated PCT values. No specific PCT algorithm was utilized.ResultsA total of 857 patients were retrospectively analyzed. Physicians complied with 73.7% of ASP recommendations. There were no significant differences in LOS based on ASP compliance. Mean LOT after ASP recommendations and mean total LOT were significantly shorter (2.5 vs 3.9 days, P < .0001 and 5.1 vs 6.6 days, P < .0001, respectively) in the ASP complier group. When stratified by initial PCT levels, ASP compliers for patients with normal PCT levels had the shortest duration of therapy for all groups; among patients with elevated PCT levels, the duration of therapy was significantly shorter in the ASP compliant group (5.79 vs 7.12 days, P < .0111). When controlling for baseline differences in initial PCT levels, LOS was found to be marginally shorter in the ASP compliant group (P = .076).ConclusionsProcalcitonin-guided ASP physician recommendations, when accepted by providers, led to reduction in LOT in a community hospital. This benefit was extended across patient groups irrespective of initial PCT levels.

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Impact of Procalcitonin Guidance with an Educational Program on Management of Adults Hospitalized with Pneumonia

Cited by 22 publications

References 27 publications

The role of procalcitonin in differential diagnosis between acute radiation pneumonitis and bacterial pneumonia in lung cancer patients receiving thoracic radiotherapy

The role of procalcitonin in differential diagnosis between acute radiation pneumonitis and bacterial pneumonia in lung cancer patients receiving thoracic radiotherapy

Procalcitonin in clinical practice: from diagnosis of sepsis to antibiotic therapy

Impact of Procalcitonin Levels Combined with Active Intervention on Antimicrobial Stewardship in a Community Hospital

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