Procalcitonine et méningites virales : réduction des traitements antibiotiques inutiles par le dosage en routine au cours d’une épidémie

Marc, E.; Ménager, C.; Moulin, F.; Stos, Bertrand; Chalumeau, Martin; Guérin, Sylvie; Lebon, Pierre; Brunet, F.; Raymond, Josette; Gendrel, D.

doi:10.1016/s0929-693x(01)00793-x

Cited by 59 publications

(14 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Antibiotic treatment was prescribed in the emergency unit to 31 patients in the VM group, even though all these patients had a serum PCT level < 0.12 ng/ml. In the pediatric context, a study focusing on the impact of serum PCT level on the duration of antibiotic treatment was performed during an epidemic of meningitis caused by enterovirus [45]. The treatment duration was found to be shorter by 2.4 days per patient in the group of patients with VM whose PCT level was determined 3 times per week.…”

Section: Discussionmentioning

confidence: 99%

Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis

et al. 2011

View full text Add to dashboard Cite

IntroductionThe objective of this study was to determine the ability of various parameters commonly used for the diagnosis of acute meningitis to differentiate between bacterial and viral meningitis, in adult patients with a negative direct cerebrospinal fluid (CSF) examination.MethodsThis was a prospective study, started in 1997, including all patients admitted to the emergency unit with acute meningitis and a negative direct CSF examination. Serum and CSF samples were taken immediately on admission. The patients were divided into two groups according to the type of meningitis: bacterial (BM; group I) or viral (VM; group II). The CSF parameters investigated were cytology, protein, glucose, and lactate; the serum parameters evaluated were C-reactive protein and procalcitonin. CSF/serum glucose and lactate ratios were also assessed.ResultsOf the 254 patients with meningitis with a negative direct CSF examination, 35 had BM and 181, VM. The most highly discriminative parameters for the differential diagnosis of BM proved to be CSF lactate, with a sensitivity of 94%, a specificity of 92%, a negative predictive value of 99%, a positive predictive value of 82% at a diagnostic cut-off level of 3.8 mmol/L (area under the curve (AUC), 0.96; 95% confidence interval (CI), 0.95 to 1), and serum procalcitonin, with a sensitivity of 95%, a specificity of 100%, a negative predictive value of 100%, and a positive predictive value of 97% at a diagnostic cut-off level of 0.28 ng/ml (AUC, 0.99; 95% CI, 0.99 to 1).ConclusionsSerum procalcitonin and CSF lactate concentrations appear to be the most highly discriminative parameters for the differential diagnosis of BM and VM.

show abstract

Section: Discussionmentioning

confidence: 99%

Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis

et al. 2011

View full text Add to dashboard Cite

show abstract

“…In such infections, including viral meningitis, the level is frequently Ͻ1 ng/mL and often in the indeterminate range (118), whereas levels are markedly increased in bacterial meningitis (119).…”

Section: Sepsismentioning

confidence: 99%

Procalcitonin assay in systemic inflammation, infection, and sepsis: Clinical utility and limitations

Becker

Snider

Nylen

2008

Critical Care Medicine

531

354

View full text Add to dashboard Cite

Based on available data, the measurement of serum ProCT has definite utility as a marker of severe systemic inflammation, infection, and sepsis. However, publications concerning its diagnostic and prognostic utility are contradictory. In addition, patient characteristics and clinical settings vary markedly, and the data have been difficult to interpret and often extrapolated inappropriately to clinical usage. Furthermore, attempts at meta-analyses are greatly compromised by the divergent circumstances of reported studies and by the sparsity and different timing of the ProCT assays. Although a high ProCT commonly occurs in infection, it is also elevated in some noninfectious conditions. Thus, the test is not a specific indicator of either infection or sepsis. Moreover, in any individual patient, the precipitating cause of an illness, the clinical milieu, and complicating conditions may render tenuous any reliable estimations of severity or prognosis. It also is apparent that even a febrile septic patient with documented bacteremia may not necessarily have a serum ProCT that is elevated above the limit of functional sensitivity of the assay. In this regard, the most commonly applied assay (i.e., LUMItest) is insufficiently sensitive to detect potentially important mild elevations or trends. Clinical studies with a more sensitive ProCT assay that is capable of rapid and practicable day-to-day monitoring are needed and shortly may be available. In addition, investigations showing that ProCT and its related peptides may have mediator relevance point to the need for evaluating therapeutic countermeasures and studying the pathophysiologic effect of hyperprocalcitonemia in serious infection and sepsis.

show abstract

“…Several older studies evaluated PCT-guided therapy in meningitis and determined that PCT-guided therapy reduces antimicrobial consumption during a viral outbreak [72]. Two recent meta-analyses confirmed PCT’s accuracy in differentiating viral from bacterial meningitis [73, 74].…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Sager

Kutz

Müeller

et al. 2017

BMC Med

240

181

View full text Add to dashboard Cite

Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i.e., pneumonia). In these indications, PCT levels measured on hospital admission were found to substantially reduce the initiation of antibiotic treatment in low-risk situations (i.e., bronchitis, chronic obstructive pulmonary disease exacerbation). For more severe infections (i.e., pneumonia, sepsis), antibiotic stewardship by monitoring of PCT kinetics resulted in shorter antibiotic treatment durations with early cessation of therapy. Importantly, these strategies appear to be safe without increasing the risk for mortality, recurrent infections, or treatment failures. PCT kinetics also proved to have prognostic value correlating with disease severity (i.e., pancreatitis, abdominal infection) and resolution of illness (i.e., sepsis). Although promising findings have been published in these different types of infections, there are a number of limitations regarding PCT, including suboptimal sensitivity and/or specificity, which makes a careful interpretation of PCT in the clinical context mandatory. This narrative review aims to update clinicians on the strengths and limitations of PCT for patient management, focusing on research conducted within the last 4 years.

show abstract

Procalcitonine et méningites virales : réduction des traitements antibiotiques inutiles par le dosage en routine au cours d’une épidémie

Cited by 59 publications

References 15 publications

Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis

Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis

Procalcitonin assay in systemic inflammation, infection, and sepsis: Clinical utility and limitations

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Contact Info

Product

Resources

About