Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients*

Layios, Nathalie; Lambermont, Bernard; Canivet, Jean-Luc; Morimont, Philippe; Preiser, Jean‐Charles; Garweg, Christophe; Ledoux, Didier; Frippiat, Frédéric; Piret, Sonia; Giot, Jean-Baptiste; Wiesen, Patricia; Meuris, Christelle; Massion, Paul; Léonard, Philippe; Nys, Monique; Lancellotti, Patrizio; Chapelle, Jean-Paul; Damas, Pierre

doi:10.1097/ccm.0b013e318251517a

Cited by 117 publications

(92 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, further evidence is needed to support this contention. In the previously mentioned study of ICU patients, 22 no advantage was seen with procalcitonin protocol use, while a systematic review of studies in ICU patients suggested some advantages to its use. 21 Available randomized trials of procalcitonin protocols in CAP patients lack comparisons with the use of other evidence-based guidelines.…”

Section: Discussionmentioning

confidence: 95%

“…6,21 More recently, in a single-center randomized controlled trial of ICU patients in Belgium, antibiotic consumption was not reduced and test sensitivity and specificity were suboptimal in differentiating confirmed and probable infection from possible and no infection, with an ROC curve area of 0.69. 22 Similar studies, preferably multicenter and international, should be performed to examine procalcitonin protocol use in CAP patients. Figure 3.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Use in Community Acquired Pneumonia

et al. 2013

View full text Add to dashboard Cite

BACKGROUND:Although prior randomized trials have demonstrated that procalcitonin-guided antibiotic therapy effectively reduces antibiotic use in patients with community-acquired pneumonia (CAP), uncertainties remain regarding use of procalcitonin protocols in practice. OBJECTIVE: To estimate the cost-effectiveness of procalcitonin protocols in CAP. DESIGN: Decision analysis using published observational and clinical trial data, with variation of all parameter values in sensitivity analyses. PATIENTS: Hypothetical patient cohorts who were hospitalized for CAP. INTERVENTIONS: Procalcitonin protocols vs. usual care. MAIN MEASURES: Costs and cost per quality adjusted life year gained. KEY RESULTS: When no differences in clinical outcomes were assumed, consistent with clinical trials and observational data, procalcitonin protocols cost $10-$54 more per patient than usual care in CAP patients. Under these assumptions, results were most sensitive to variations in: antibiotic cost, the likelihood that antibiotic therapy was initiated less frequently or over shorter durations, and the likelihood that physicians were nonadherent to procalcitonin protocols. Probabilistic sensitivity analyses, incorporating procalcitonin protocol-related changes in quality of life, found that protocol use was unlikely to be economically reasonable if physician protocol nonadherence was high, as observational study data suggest. However, procalcitonin protocols were favored if they decreased hospital length of stay. CONCLUSIONS: Procalcitonin protocol use in hospitalized CAP patients, although promising, lacks physician nonadherence and resource use data in routine care settings, which are needed to evaluate its potential role in patient care.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Use in Community Acquired Pneumonia

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Layios et al (32) applied a PCT algorithm where antibiotics were discouraged if PCT <0.25 ng/mL and encouraged if PCT >1 ng/mL in 509 patients suspected of infection on admission or during ICU stay and found no difference in the rate of initiation of therapy, percentage of days on antibiotics or overall defined daily dose of antibiotics between PCT and control groups. Bouadma et al (33) in the PRORATA trial (n=630) used a similar algorithm and showed a reduction of antibiotic exposure in the PCT group (more days without antibiotics, 14.3±9.1 vs. 11.6±8.2 days in control group, 95% CI, P<0.0001) and a 7% absolute risk reduction for initiating antibiotics.…”

Section: Adult Icu Patientsmentioning

confidence: 99%

Biomarker-guided antibiotic therapy—strengths and limitations

et al. 2017

View full text Add to dashboard Cite

Biomarkers as C-reactive protein (CRP) and procalcitonin (PCT) emerged as tools to help clinicians to diagnose infection and to properly initiate and define the duration of antibiotic therapy. Several randomized controlled trials, including adult critically ill patients, showed that PCT-guided antibiotic stewardship was repeatedly associated with a decrease in the duration of antibiotic therapy with no apparent harm. There are however some relevant limitations in these trials namely the low rate of compliance of PCTguided algorithms, the high rate of exclusion (without including common clinical situations and pathogens) and the long duration of antibiotic therapy in control groups. Such limitations weakened the real impact of such algorithms in the clinical decision-making process and strengthened the concept that the initiation and the duration of antibiotic therapy cannot depend solely on a biomarker. Future efforts should address these limitations in order to better clarify the role of biomarkers on the complex and multifactorial issue of antibiotic management and to deeply understand its potential effect on mortality.

show abstract

“…The growing pressure of multidrug-resistant bacteria in the ICU environment, combined with considerations regarding cost and limitation of drug toxicity and interactions [26,27], offered the perfect opportunity for a new appraisal of this biomarker, which had somehow failed to fulfill its promises. It is considered to be useful because of favorable kinetics [28] and a high negative predictive value [17,[29][30][31].…”

Section: Core Textmentioning

confidence: 99%

Procalcitonin for Antibiotic Treatment in Intensive Care Unit Patients

Layios¹,

Lambermont

2013

Curr Infect Dis Rep

Self Cite

View full text Add to dashboard Cite

Procalcitonin (PCT), a 116-aminoacids prohormone, has been substantially studied over the last 2 decades in the field of sepsis. Disappointingly low sensitivity values led to the abandonment of the concept of it as a diagnostic tool and then to its being considered more as a prognostic marker with a good correlation with severe infection. Later on, growing concerns about multidrug-resistant bacteria in the ICU environment and about the cost and side effects of antibiotics suggested that PCT might prove to be a valuable asset in stewardship programs. Numerous but hardly comparable randomized controlled trials assessing either initiation or deescalation in ICU patients have been published. Stewardship encompassing PCT should focus on the latter, because of the high negative predictive value of this biomarker. However, there still would be safety concerns if a systematic implementation of PCT were to be considered in daily stewardship programs in the ICU, especially in extrathoracic sepsis.

show abstract

Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients*

Abstract: Procalcitonin measuring for the initiation of antimicrobials did not appear to be helpful in a strategy aiming at decreasing the antibiotic consumption in intensive care unit patients.

Cited by 117 publications

References 17 publications

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Use in Community Acquired Pneumonia

Cost-Effectiveness of Procalcitonin-Guided Antibiotic Use in Community Acquired Pneumonia

Biomarker-guided antibiotic therapy—strengths and limitations

Procalcitonin for Antibiotic Treatment in Intensive Care Unit Patients

Contact Info

Product

Resources

About