Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial

Hochreiter, Marcel; Köhler, Thomas; Schweiger, A.-M.; Keck, F. S.; Bein, Berthold; Spiegel, T. von; Schroeder, Stefan

doi:10.1186/cc7903

Cited by 277 publications

(257 citation statements)

References 28 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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“…Administered antibiotic for long time can cause side effects such as allergic reactions, antibiotic-associated colitis, and even death due to MDR. 10 Bacterial resistance to antibiotics occurs through the changes of bacterial genetic structure such as gene mutation. Genetic materials are capable of making the bacteria resistant through three main mechanisms, such as producing enzymes that inactivate or destroy antibiotics, changing the antibiotic target binding to the bacteria, and preventing access to the target itself.…”

Section: Discussionmentioning

confidence: 99%

Quality Assesment of Antibiotic Prescription for Sepsis Treatment in Intensive Care Unit at Top Referral Hospital in West Java, Indonesia

Adani¹,

Zulfariansyah²,

Santoso³

2017

amj

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Background: Sepsis is a common disease in intensive care unit (ICU) with high mortality rate. Administration of antibiotic has an important role to determine the outcome of sepsis patient. This study aimed to evaluate the quality of antibiotic prescription for sepsis treatment in intensive care unit (ICU). Methods: This descriptive study was conducted by retrieving data from 48 medical records of patients with sepsis, severe sepsis, and septic shock admitted to ICU Dr. Hasan Sadikin General Hospital (RSHS) in 2013. The study was conducted from August to October 2014. Empiric therapy in the ICUat RSHS and Surviving Sepsis Campaign (SSC) guidelines in 2012 were used as a standard for antibiotic prescription. The quality of antibiotic prescription was assessed then categorized based on Gyssens criteria. The collected data were analyzed in the form of frequency and percentage and presented in tables.Results: This study discovered that most of the patients had severe sepsis and septic shock. Based on Gyssens criteria, 35% antibiotic uses were included into category 0 (proper); 1.4% category I (improper timing); 10.5% category IIA (improper dosage); 9.1% category IIB (improper interval); 3.5% category IIC (improper route); 12.6% category IIIA (improper duration; too long); 1.4% category IIIB (improper duration; too short); 16.8% category IVA (improper; other antibiotics were more effective); 4.2% category IVD (improper; other antibiotics had narrower spectrum); and 5.6% category V (improper; no indication). Conclusions: There are still improper uses of antibiotic for sepsis, severe sepsis, and septic shock patients in the ICU.

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“…Moreover, in sepsis patients, particularly bacterial, initial PCT values proved to be far higher. The mean values ranged from 4.3 (nonsevere sepsis) to 21.3 ng/mL (septic shock) (5,14,15) . In the present study, the median PCT values in patients with sepsis and trauma were similar to those found by Castelli et al (13) and Billeter et al (3) , respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Only the initial value (upon ICU admission) of serum PCT was analyzed. The dynamics of PCT in patients with sepsis (5) , in postoperative care (15) , with ventilator-associated pneumonia (4) , and with trauma (3,13) prove to be more useful than the initial dosage. Heterogeneity among the non-H1N1 patients hinders comparisons between the groups.…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin in patients with influenza A (H1N1) infection and acute respiratory failure

Duarte

Bredt

et al. 2011

Einstein (São Paulo)

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Objective: To verify serum procalcitonin levels of patients with acute respiratory failure secondary to influenza A (H1N1) upon their admission to the Intensive Care Unit and to compare these results to values found in patients with sepsis and trauma admitted to the same unit. Methods: Analysis of records of patients infected with influenza A (H1N1) and respiratory failure admitted to the General Intensive Care Unit during in a period of 60 days. The values of serum procalcitonin and clinical and laboratory data were compared to those of all patients admitted with sepsis or trauma in the previous year. Results: Among patients with influenza A (H1N1) (n = 16), the median serum procalcitonin level upon admission was 0.11 ng/mL, lower than in the sepsis group (p < 0.001) and slightly lower than in trauma patients. Although the mean values were low, serum procalcitonin was a strong predictor of hospital mortality in patients with influenza A (H1N1). Conclusion: Patients with influenza A (H1N1) with severe acute respiratory failure presented with low serum procalcitonin values upon admission, although their serum levels are predictors of hospital mortality. The kinetics study of this biomarker may be a useful tool in the management of this group of patients.

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Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial

Cited by 277 publications

References 28 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

Quality Assesment of Antibiotic Prescription for Sepsis Treatment in Intensive Care Unit at Top Referral Hospital in West Java, Indonesia

Procalcitonin in patients with influenza A (H1N1) infection and acute respiratory failure

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