Effect of procalcitonin-based guidelines compared with standard guidelines on antibiotic use in lower respiratory tract infections: the randomized-controlled multicenter ProHOSP trial

Schuetz, Philipp; Thomann, Robert V.; Falconnier, Claudine; Wolbers, Marcel; Widmer, Isabelle; Neidet, S; Blum, C; Fricker, Thomas; Schild, Ursula; Regez, Katharina; Schoenenberger, Ronald A.; Henzen, Christoph; Bregenzer, Thomas; Krausse, M; Hoess, Claus; Bucher, Heiner C.; Zimmerli, Werner; Müeller, Beat

doi:10.1186/cc7550

Cited by 205 publications

(341 citation statements)

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“…This reduction in treatment duration was also seen in patients with acute exacerbations of COPD (PCT 2.5 days versus control 5.1 days). 14 These results and those from other studies suggest that PCT has a role as a biomarker for acute bacterial exacerbations of COPD and that it can be used safely to reduce inappropriate antibiotics in acute exacerbations of COPD. We and others have demonstrated that CRP is a similarly sensitive and specific biomarker to identify patients who require antibiotics and may be a reliable, widelyavailable alternative to PCT.…”

Section: Targeted Antibiotic Treatment For Copdsupporting

confidence: 71%

Phenotyping chronic obstructive pulmonary disease (COPD) exacerbations: realising personalised medicine

Brightling

Barker

2012

Clinical Medicine

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Section: Targeted Antibiotic Treatment For Copdsupporting

confidence: 71%

Phenotyping chronic obstructive pulmonary disease (COPD) exacerbations: realising personalised medicine

Brightling

Barker

2012

Clinical Medicine

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“…A total of 268 patients hospitalized for CAP and available blood specimens from a previous Swiss multicenter trial [13,14] were included in this analysis. The initial trial included 925 (68%) CAP patients in which all-cause mortality was 45% over a follow-up period of 6 years [15].…”

Section: Methodsmentioning

confidence: 99%

“…The primary goal of the study was to verify the efficacy and safety of using the procalcitonin (PCT) level to guide the initiation and duration of antibiotic therapy in patients with lower respiratory tract infections [13,14]. Patients at least 18 years of age presenting from the community or a nursing home to the emergency department (ED) were included if they fulfilled at least one of the following criteria: cough, dyspnea, pleural pain, sputum production or tachypnea and one infectious sign (core body temperature > 38 °C, shivering, white blood cell count > 10 or < 4 cells × 10 9 L - 1 ) or one finding during auscultation (rales or crepitation).…”

Section: Methodsmentioning

confidence: 99%

Activation of the tryptophan/serotonin pathway is associated with severity and predicts outcomes in pneumonia: results of a long-term cohort study

Meier

Ottiger

Vögeli

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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Background: As part of the immune defense during infection, an increase in enzyme activity of indoleamine 2,3-dioxygenase (IDO) leads to a breakdown of tryptophan to kynurenine. In previous animal studies, therapeutic antagonism of IDO resulted in reduced sepsis mortality. We investigated the prognostic ability of tryptophan, serotonin, kynurenine and IDO (represented by the ratio of kynurenine/tryptophan) to predict adverse clinical outcomes in patients with community-acquired pneumonia (CAP). Methods: We measured tryptophan, serotonin and kynurenine on admission plasma samples from CAP patients included in a previous multicenter trial by liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). We studied their association with inflammation (C-reactive protein), infection (procalcitonin) and clinical outcome. Results: Mortality in the 268 included patients was 45% within 6 years of follow-up. IDO and kynurenine showed a

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“…This is a prospective 18-month follow-up study including all CAP patients who were previously enrolled in a multicentre trial (ProHOSP trial) and who were discharged post-survival of an initial CAP episode [24,25]. Patients were included from October 2006 to March 2008 in one of six participating centres in Switzerland.…”

Section: Study Sample and Trial Flowmentioning

confidence: 99%

“…In addition, the performance of blood markers, which correlate with short-term risks for prediction of long-term mortality, has not been studied systematically. The aim of this study, therefore, was to investigate the long-term prognostic performance of the PSI score and the association of clinical parameters and different blood biomarkers with long-term mortality rate in a large cohort of patients with CAP from a previous multicentre study [24,25].…”

mentioning

confidence: 99%

Inflammatory responses predict long-term mortality risk in community-acquired pneumonia

Guertler

Wirz²,

Christ‐Crain³

et al. 2010

European Respiratory Journal

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Long-term outcomes in patients surviving community-acquired pneumonia (CAP) are still incompletely understood. This study investigates the association of clinical parameters and blood markers with long-term mortality.We prospectively followed 877 CAP patients from a previous multicentre trial for 18 months follow-up and investigated all-cause mortality following hospital discharge.Overall mortality was 17.3% (95% CI 14.8-19.8%) with a 12.8% (95% CI 10.9-15.0%) mortality incidence rate per year. Initial risk assignment using the Pneumonia Severity Index was accurate during the 18 month follow-up. Multivariable regression models (hazard ratio, 95% CI) designated the following as independent risk factors for long-term mortality: male sex (1.7, 1.2-2.5); chronic obstructive pulmonary disease (1.5, 1.1-2.1); neoplastic disease (2.5, 1.7-3.7); and highest quartile of peak pro-adrenomedullin level (3.3, 1.7-6.2). Initial presentation with temperature .38.7uC (0.4, 0.2-0.6), chills (0.6, 0.4-0.99) and highest quartile of the inflammatory marker C-reactive-protein (0.3, 0.2-0.5) were independent protective factors. A weighted risk score based on these variables showed good discrimination (area under receiver operating characteristic curve 0.78, 95% CI 0.74-0.82).Pronounced clinical and laboratory signs of systemic inflammatory host response upon initial hospital stay were associated with favourable long-term prognosis. Further studies should address whether closer monitoring of high-risk CAP patients after hospital discharge favourably impacts long-term mortality.

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Effect of procalcitonin-based guidelines compared with standard guidelines on antibiotic use in lower respiratory tract infections: the randomized-controlled multicenter ProHOSP trial

Cited by 205 publications

References 0 publications

Phenotyping chronic obstructive pulmonary disease (COPD) exacerbations: realising personalised medicine

Phenotyping chronic obstructive pulmonary disease (COPD) exacerbations: realising personalised medicine

Activation of the tryptophan/serotonin pathway is associated with severity and predicts outcomes in pneumonia: results of a long-term cohort study

Inflammatory responses predict long-term mortality risk in community-acquired pneumonia

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