Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study

Schroeder, Stefan; Hochreiter, Marcel; Koehler, Tracy J.; Schweiger, A.-M.; Bein, Berthold; Keck, F. S.; Spiegel, T. von

doi:10.1007/s00423-008-0432-1

Cited by 207 publications

(217 citation statements)

References 26 publications

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“…A systematic review and metaanalysis published in 2013 showed that PCT-guided therapy significantly reduced the duration of antimicrobial therapy with no effect on mortality, or length of ICU and hospital stay. The risks of bias in included studies were mostly low or unclear (42)(43)(44)(45)(46)(47)(48). Only one study by Jensen and coworkers was considered to have high risk of bias in terms of selective reporting (46).…”

Section: Evidence From Rctsmentioning

confidence: 99%

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Zhang¹,

Smischney²,

Zhang³

et al. 2016

J. Thorac. Dis.

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Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques. As a consequence, diagnostic criteria for sepsis need regular revision to cope with emerging evidence. This review aims to present the most updated information on diagnosis and early recognition of sepsis. Recommendations for

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Section: Evidence From Rctsmentioning

confidence: 99%

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Zhang¹,

Smischney²,

Zhang³

et al. 2016

J. Thorac. Dis.

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“…However, two studies 115,116 using the LIA were identified by our searches; one study 115 assessed the addition of PCT levels to the information used to decide whether or not to initiate antibiotic treatment in patients post cardiac surgery and found that use of PCT was associated with a reduction in antibiotic exposure (RR 0.40, 95% CI 0.25 to 0.63), and the other study 116 assessed the addition of a PCT algorithm to the information used to decide when to discontinue antibiotics in people with severe sepsis who were being treated in an ICU and found that the PCT algorithm was associated with a reduction in the duration of antibiotic treatment (mean difference -1.70 days, 95% CI -2.39 to -1.01 days). Neither study 115,116 found a statistically significant difference in any adverse clinical outcome between the intervention and control groups. The results of these two studies 115,116 further support the view that there is no evidence to suggest that the effects of including PCT information in decisions about antibiotic treatment differ according to which PCT assay is used.…”

Section: Clinical Effectivenessmentioning

confidence: 99%

Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis

Westwood

Ramaekers

Whiting

et al. 2015

Health Technol Assess

122

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BackgroundDetermination of the presence or absence of bacterial infection is important to guide appropriate therapy and reduce antibiotic exposure. Procalcitonin (PCT) is an inflammatory marker that has been suggested as a marker for bacterial infection.ObjectivesTo assess the clinical effectiveness and cost-effectiveness of adding PCT testing to the information used to guide antibiotic therapy in adults and children (1) with confirmed or highly suspected sepsis in intensive care and (2) presenting to the emergency department (ED) with suspected bacterial infection.MethodsTwelve databases were searched to June 2014. Randomised controlled trials were assessed for quality using the Cochrane Risk of Bias tool. Summary relative risks (RRs) and weighted mean differences (WMDs) were estimated using random-effects models. Heterogeneity was assessed visually using forest plots and statistically using theI2andQstatistics and investigated through subgroup analysis. The cost-effectiveness of PCT testing in addition to current clinical practice was compared with current clinical practice using a decision tree with a 6 months’ time horizon.ResultsEighteen studies (36 reports) were included in the systematic review. PCT algorithms were associated with reduced antibiotic duration [WMD –3.19 days, 95% confidence interval (CI) –5.44 to –0.95 days,I2 = 95.2%; four studies], hospital stay (WMD –3.85 days, 95% CI –6.78 to –0.92 days,I2 = 75.2%; four studies) and a trend towards reduced intensive care unit (ICU) stay (WMD –2.03 days, 95% CI –4.19 to 0.13 days,I2 = 81.0%; four studies). There were no differences for adverse clinical outcomes. PCT algorithms were associated with a reduction in the proportion of adults (RR 0.77, 95% CI 0.68 to 0.87; seven studies) and children (RR 0.86, 95% CI 0.80 to 0.93) receiving antibiotics, reduced antibiotic duration (two studies). There were no differences for adverse clinical outcomes. All but one of the studies in the ED were conducted in people presenting with respiratory symptoms.Cost-effectiveness: the base-case analyses indicated that PCT testing was cost-saving for (1) adults with confirmed or highly suspected sepsis in an ICU setting; (2) adults with suspected bacterial infection presenting to the ED; and (3) children with suspected bacterial infection presenting to the ED. Cost-savings ranged from £368 to £3268. Moreover, PCT-guided treatment resulted in a small quality-adjusted life-year (QALY) gain (ranging between < 0.001 and 0.005). Cost-effectiveness acceptability curves showed that PCT-guided treatment has a probability of ≥ 84% of being cost-effective for all settings and populations considered (at willingness-to-pay thresholds of £20,000 and £30,000 per QALY).ConclusionsThe limited available data suggest that PCT testing may be effective and cost-effective when used to guide discontinuation of antibiotics in adults being treated for suspected or confirmed sepsis in ICU settings and initiation of antibiotics in adults presenting to the ED with respiratory symptoms and suspected bacterial infection. However, it is not clear that observed costs and effects are directly attributable to PCT testing, are generalisable outside people presenting with respiratory symptoms (for the ED setting) and would be reproducible in the UK NHS. Further studies are needed to assess the effectiveness of adding PCT algorithms to the information used to guide antibiotic treatment in children with suspected or confirmed sepsis in ICU settings. Additional research is needed to examine whether the outcomes presented in this report are fully generalisable to the UK.Study registrationThis study is registered as PROSPERO CRD42014010822.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…So konnte in mehreren Studien bei Intensivpatienten mit Sepsis mittels eines vergleichbaren PCT-gesteuerten Algorithmus der Antibiose-Verbrauch reduziert werden ohne die Komplikationsrate, die Mortalit ä t oder den Intensivaufenthalt zu verschlechtern [34,35] . Schlie ß lich konnte der Benefi t einer PCT-gesteuerten antibiotischen Therapie in einer multizentrischen Studien an nicht-chirurgischen Intensivpatienten mit Verdacht auf eine Infektion [36] best ä tigt werden.…”

Section: Klinische Anwendung Der Pct-spiegel Infektionsmarkerunclassified

Wie verlässlich ist die Bestimmung von Procalcitonin als Entzündungsmarker auf Intensivstation?/How reliable is procalcitonin as an inflammatory marker?

Biller

Fae

Germann

et al. 2011

LaboratoriumsMedizin

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Zusammenfassung Die Rolle von Procalcitonin (PCT)-Plasmaspiegel bei kritisch kranken Patienten wurde in den vergangenen Jahren intensiv untersucht. Insbesondere zur Erkennung von Infektionen erwiesen sich PCT-Plasmaspiegel in vielen Fällen anderen klinischen und biochemischen Markern überlegen. Neuere Untersuchungen zeigen, dass mit Hilfe der PCT-Spiegel bei bestimmten Erkrankungen die antibiotische Therapie gesteuert und damit der Antibiotika-Verbrauches reduziert werden kann. Für die Beurteilung der Prognose von kritisch kranken Intensivpatienten scheint der Parameter jedoch nur eingeschränkt verwertbar zu sein. Darüber hinaus können in seltenen Fällen falsch positive und falsch negative Werte auftreten. Trotz dieser Einschränkungen werden heutzutage PCT-Plasmaspiegel bereits vielfältig auf Intensivstationen eingesetzt. Die möglichen klinischen Anwendungen dieses Labormarkers als diagnostisches Werkzeug zur Beurteilung kritisch kranker Patienten sollen im Folgenden dargestellt werden.

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Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study

Abstract: Monitoring of PCT is a helpful tool for guiding antibiotic treatment in surgical intensive care patients with severe sepsis. This may contribute to an optimized antibiotic regimen with beneficial effects on microbial resistances and costs in intensive care medicine.

Cited by 207 publications

References 26 publications

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis

Wie verlässlich ist die Bestimmung von Procalcitonin als Entzündungsmarker auf Intensivstation?/How reliable is procalcitonin as an inflammatory marker?

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