Low procalcitonin, community acquired pneumonia, and antibiotic therapy

Kamat, Ishan; Ramachandran, Vignesh; Eswaran, Harish; Musher, Daniel M.

doi:10.1016/s1473-3099(18)30215-9

Cited by 15 publications

(9 citation statements)

References 5 publications

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“…Combined with the modest sample size and absence of information on pre-hospital antibiotic prescriptions, we were not able to define the true relationship between PCT and bacterial co-infections in COVID-19, highlighting the importance of not using PCT measurements alone to guide antibiotic prescribing. 10 , 17 However, similar to others, 18 we observed the relationship between inflammatory markers to be consistent throughout the hospital stay, indicating that inferred or measured PCT may be most useful in discontinuing antibiotics rather than withholding their initiation on admission, a timepoint accompanied by greater diagnostic uncertainty. Finally, liver dysfunction and immunomodulators (e.g.…”

Section: Discussionsupporting

confidence: 86%

C-reactive protein-guided use of procalcitonin in COVID-19

Houghton

Moore

Williams

et al. 2021

JAC-Antimicrobial Resistance

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Background A low procalcitonin (PCT) concentration facilitates exclusion of bacterial co-infections in COVID-19, but high costs associated with PCT measurements preclude universal adoption. Changes in inflammatory markers, including C-reactive protein (CRP), can be concordant, and predicting low PCT concentrations may avoid costs of redundant tests and support more cost-effective deployment of this diagnostic biomarker. Objectives To explore whether, in COVID-19, low PCT values could be predicted by the presence of low CRP concentrations. Methods Unselected cohort of 224 COVID-19 patients admitted to hospital that underwent daily PCT and CRP measurements as standard care. Both 0.25 ng/mL and 0.5 ng/mL were used as cut-offs for positive PCT test results. Geometric mean was used to define high and low CRP values at each timepoint assessed. Results Admission PCT was <0.25 ng/mL in 160/224 (71.4%), 0.25–0.5 ng/mL in 27 (12.0%) and >0.5 ng/mL in 37 (16.5%). Elevated PCT was associated with increased risk of death (P = 0.0004) and was more commonly associated with microbiological evidence of bacterial co-infection (P < 0.0001). For high CRP values, significant heterogeneity in PCT measurements was observed, with maximal positive predictive value of 50% even for a PCT cut-off of 0.25 ng/mL. In contrast, low CRP was strongly predictive of low PCT concentrations, particularly <0.5 ng/mL, with a negative predictive value of 97.6% at time of hospital admission and 100% 48 hours into hospital stay. Conclusions CRP-guided PCT testing algorithms can reduce unnecessary PCT measurement and costs, supporting antimicrobial stewardship strategies in COVID-19.

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Section: Discussionsupporting

confidence: 86%

C-reactive protein-guided use of procalcitonin in COVID-19

Houghton

Moore

Williams

et al. 2021

JAC-Antimicrobial Resistance

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“…However, a recent study in hospitalized patients with CAP failed to identify a procalcitonin threshold that discriminated between viral and bacterial pathogens, although higher procalcitonin strongly correlated with increased probability of a bacterial infection ( 37 ). The reported sensitivity of procalcitonin to detect bacterial infection ranges from 38% to 91%, underscoring that this test alone cannot be used to justify withholding antibiotics from patients with CAP ( 38 ).…”

Section: Recommendationsmentioning

confidence: 99%

“…The recommendation to routinely prescribe antibacterial agents in patients with influenza virus infection and pneumonia was based on evidence suggesting that bacterial coinfections are a common and serious complication of influenza, as well as the inability to exclude the presence of bacterial coinfection in a patient with CAP who has a positive test for influenza virus. Although low levels of biomarkers such as procalcitonin decrease the likelihood that patients have bacterial infections, these biomarkers do not completely rule out bacterial pneumonia in an individual patient with sufficient accuracy to justify initially withholding antibiotic therapy, especially among patients with severe CAP ( 37 , 38 , 193 ). We have provided a strong recommendation because of the significant risk of treatment failure in delaying appropriate antibacterial therapy in patients with CAP.…”

Section: Recommendationsmentioning

confidence: 99%

Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

Metlay¹,

Waterer²,

Long³

et al. 2019

Am J Respir Crit Care Med

2,501

2,232

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Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia. Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions. Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.

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“…Despite the similarities in the etiology and pathogenesis of CAP, there are some differences in the approaches to the pharmacotherapy over the world. For example, the guidelines for management of CAP patients, developed by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) and revised in 2019 (Kamat et al 2018;Wan et al 2019), offer the following guidelines for managing patients with CAP:…”

Section: Resultsmentioning

confidence: 99%

Modern approaches to pharmacotherapy of Community-Acquired Pneumonia

Gavrilova¹,

Bontsevich²,

Vovk³

et al. 2020

RRP

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Introduction: The study presents current views on the pharmacotherapy of community-acquired pneumonia (CAP). This study also describes in general terms the current pharmacoepidemiological situation of the CAP in Russia and abroad, which can both help medical professionals make an informed choice when choosing a pharmacotherapy, and inspire them to follow-up research and observations. The aim of the study is to conduct an analysis of the available research on the pharmacotherapy of CAP in order to accelerate the accumulation and assimilation of knowledge in the field of this pathology. Materials and methods: The following databases of medical publications and electronic libraries were used to search for the relevant sources of information: PubMed, Medline, Google Scholar, Crossref, and eLIBRARY.RU. Results and discussion: The choice of a rational antimicrobial therapy (AMT) for CAP is of high relevance due to the widespread of the pathology. The article highlights modern approaches to the pharmacotherapy of CAP in adults, including a review of promising new drugs, and presents the main problematic issues related to the emergence of antibiotic resistance of pathogens, as well as methods to combat it. Conclusion: The analyzed and generalized results of the conducted research allow the authors to make a conclusion about the feasibility of a more detailed study and raising the level of awareness of medical professionals in this pathology.

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Low procalcitonin, community acquired pneumonia, and antibiotic therapy

Cited by 15 publications

References 5 publications

C-reactive protein-guided use of procalcitonin in COVID-19

C-reactive protein-guided use of procalcitonin in COVID-19

Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

Modern approaches to pharmacotherapy of Community-Acquired Pneumonia

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