Point-of-care procalcitonin test to reduce antibiotic exposure in patients hospitalized with acute exacerbation of COPD

Corti, Caspar; Fally, Markus; Fabricius‐Bjerre, Andreas; Mortensen, K; Jensen, Birgitte Nybo; Andreassen, Helle Frost; Porsbjerg, Celeste; Knudsen, Jenny Dahl; Jensen, Jens-Ulrik

doi:10.2147/copd.s104051

Cited by 57 publications

(69 citation statements)

References 28 publications

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“…The impact of PCT monitoring in patients with LRTIs was studied in a variety of randomized controlled trials, mainly in the inpatient setting (Table ). Overall, studies in this patient population demonstrated that PCT monitoring, when compared with standard care (no PCT monitoring), results in a reduction in antibiotic therapy duration in the range of 0–8 days, with no corresponding impact on infection relapses . A large meta‐analysis detected a significant reduction in 30‐day mortality in patients with acute respiratory infections receiving PCT‐guided therapy compared with those receiving standard care (9% vs 10%; adjusted OR 0.83, 95% CI 0.70–0.99, p=0.37, respectively) .…”

Section: Procalcitonin As a Determinant Of Antibiotic Therapy Durationmentioning

confidence: 87%

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Procalcitonin Monitoring as a Guide for Antimicrobial Therapy: A Review of Current Literature

2018

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Effective antimicrobial stewardship practices are increasingly essential to best utilize the current arsenal of antimicrobials for the shortest necessary duration to minimize the development of antimicrobial resistance, secondary infections, and health care costs. Monitoring of serum procalcitonin (PCT) levels represents an effective antimicrobial stewardship strategy to differentiate bacterial infections from viral infections and noninfectious inflammatory conditions. Current literature illustrates the merits of PCT monitoring in reducing duration of antibiotic therapy without detrimental effects on mortality or infection relapses. However, the interpretation of PCT levels can be challenging, especially in light of comorbid disease states that can elevate PCT levels. This review sheds light on the utility of PCT monitoring, as well as providing insight into the practical interpretation of PCT levels. Much of the current literature surrounding PCT monitoring consists of use among patients with lower respiratory tract infections or in the critically ill. Overall, studies have demonstrated shorter antibiotic therapy durations when PCT monitoring is utilized. No studies to date have found increased rates of mortality or infection relapses, suggesting that PCT monitoring is not only effective, but also safe when used as a guide for antimicrobial therapy. Nonetheless, many conditions were shown to elevate PCT serum concentrations, even in the absence of bacterial infections, which can make interpretation of PCT concentrations challenging. Two common conditions that affect the accurate interpretation of PCT levels are renal dysfunction and congestive heart failure. Limited studies have been performed in these populations, but current available data propose the need for higher PCT thresholds in those with renal dysfunction or congestive heart failure and support utilizing PCT trends to monitor clinical improvement from bacterial infections. Evidence also suggests that PCT monitoring is cost-effective, as long as the test is ordered judiciously. In summary, PCT monitoring represents a promising antimicrobial stewardship strategy to limit exposure to unnecessary antimicrobial therapy.

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Section: Procalcitonin As a Determinant Of Antibiotic Therapy Durationmentioning

confidence: 87%

“…The authors cited modest adherence and lack of serial PCT measurements as potential factors contributing to the lack of observed benefits. In other studies, adherence to PCT algorithms varies greatly, ranging from 47–97% …”

Section: Challenges Implementing Pct Monitoringmentioning

confidence: 98%

Procalcitonin Monitoring as a Guide for Antimicrobial Therapy: A Review of Current Literature

2018

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“…Inflammatory markers as a kind of quantitative indicator are widely used in judging acute exacerbation and assessing prognosis. Systemic inflammatory markers mainly include CRP,17–19 PCT,20,21 serum amyloid A,22 SP-D,23 fibrinogen,24 inflammation cell chemotactic factor,25 and so on. All the markers mentioned earlier will increase in AECOPD patients and decrease in recovery.…”

Section: Methodsmentioning

confidence: 99%

The recent advances of phenotypes in acute exacerbations of COPD

Zhou

Zhao

et al. 2017

COPD

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Exacerbations of COPD are clinically relevant events with therapeutic and prognostic implications. Yet, significant heterogeneity of clinical presentation and disease progression exists within acute exacerbations of COPD (AECOPD). Currently, different phenotypes have been widely used to describe the characteristics among patients with AECOPD. This has proved to be significant in the treatment and prediction of the outcomes of the disease. In this review of published literature, the phenotypes of AECOPD were classified according to etiology, inflammatory biomarkers, clinical manifestation, comorbidity, the frequency of exacerbations, and so on. This review concentrates on advancements in the use of phenotypes of AECOPD.

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“…However, in patients with more severe disease and/or exacerbations, Gram-negative pathogens, such as Pseudomonas aeruginosa , are common,79,80 and may prove more challenging to treat in light of increasing resistance in some regions. The role of procalcitonin as a potential biomarker for optimizing antibiotic-treatment strategy in COPD exacerbations (especially those induced by bacterial infection) is also being investigated; however, as yet its role is unproven 81,82. Further studies are required to guide optimal antibiotic treatment, based on investigation of biomarkers to identify patients expected to benefit, and to establish the optimal duration of treatment 83…”

Section: What Are the Recommended Treatment Strategies For Severe Copmentioning

confidence: 99%

Impact and prevention of severe exacerbations of COPD: a review of the evidence

Halpin¹,

Miravitlles²,

Metzdorf³

et al. 2017

COPD

185

159

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Severe exacerbations of COPD, ie, those leading to hospitalization, have profound clinical implications for patients and significant economic consequences for society. The prevalence and burden of severe COPD exacerbations remain high, despite recognition of the importance of exacerbation prevention and the availability of new treatment options. Severe COPD exacerbations are associated with high mortality, have negative impact on quality of life, are linked to cardiovascular complications, and are a significant burden on the health-care system. This review identified risk factors that contribute to the development of severe exacerbations, treatment options (bronchodilators, antibiotics, corticosteroids [CSs], oxygen therapy, and ventilator support) to manage severe exacerbations, and strategies to prevent readmission to hospital. Risk factors that are amenable to change have been highlighted. A number of bronchodilators have demonstrated successful reduction in risk of severe exacerbations, including long-acting muscarinic antagonist or long-acting β2-agonist mono- or combination therapies, in addition to vaccination, mucolytic and antibiotic therapy, and nonpharmacological interventions, such as pulmonary rehabilitation. Recognition of the importance of severe exacerbations is an essential step in improving outcomes for patients with COPD. Evidence-based approaches to prevent and manage severe exacerbations should be implemented as part of targeted strategies for disease management.

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Point-of-care procalcitonin test to reduce antibiotic exposure in patients hospitalized with acute exacerbation of COPD

Cited by 57 publications

References 28 publications

Procalcitonin Monitoring as a Guide for Antimicrobial Therapy: A Review of Current Literature

Procalcitonin Monitoring as a Guide for Antimicrobial Therapy: A Review of Current Literature

The recent advances of phenotypes in acute exacerbations of COPD

Impact and prevention of severe exacerbations of COPD: a review of the evidence

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