Procalcitonin-guided antibiotic therapy in patients with fever in a general emergency department population: a multicentre non-inferiority randomized clinical trial (HiTEMP study)

Does, Yuri van der; Limper, Maarten; Jie, Kim E.; Schuit, Stephanie C. E.; Jansen, Henry; Pernot, N.; Rosmalen, Joost van; Poley, Marten J.; Ramakers, Christian; Patka, P.; Gorp, Eric C. M. Van; Rood, P.P.M.

doi:10.1016/j.cmi.2018.05.011

Cited by 66 publications

(53 citation statements)

References 29 publications

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“…Third, the recently published HiTEMP study, investigated the value of PCT to guide antibiotic therapy in ED patients with fever in regard to rates of antibiotic prescription, clinical outcomes and costs [32]. Investigators did not find any added benefit of PCT, demonstrating that while PCT-guided therapy was non-inferior in terms of safety, it did not reduce the prescription of antibiotics.…”

Section: Learnings From 'Negative' Studiesmentioning

confidence: 99%

Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

Шуц¹,

Beishuizen²,

Бройлс³

et al. 2019

Lab. sluzh.

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Background: Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods: Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. Results: The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the

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Section: Learnings From 'Negative' Studiesmentioning

confidence: 99%

Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

Шуц¹,

Beishuizen²,

Бройлс³

et al. 2019

Lab. sluzh.

View full text Add to dashboard Cite

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“…Interestingly, MR-proADM was also the most accurate parameter in identifying patients presenting to the ED or receiving treatment on a medical ward who subsequently required immediate ICU admission. The use of clinical or laboratory parameters which are significantly increased in the early stages of the infectious cascade may allow more appropriate treatment strategies to be initiated upon initial suspicion of infection, thus minimising the risk of patients being either underor over-treated-both of which may result in undesirable consequences [21]. To this extent, the use of blood biomarkers may provide an easy and rapid source of clinical information with which to inform and help develop clinical strategies.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers and clinical scores to aid the identification of disease severity and intensive care requirement following activation of an in-hospital sepsis code

Baldirà

Ruiz‐Rodríguez

Wilson

et al. 2020

Ann. Intensive Care

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Background: Few validated biomarker or clinical score combinations exist which can discriminate between cases of infection and other non-infectious conditions following activation of an in-hospital sepsis code, as well as provide an accurate severity assessment of the corresponding host response. This study aimed to identify suitable blood biomarker (MR-proADM, PCT, CRP and lactate) or clinical score (SOFA and APACHE II) combinations to address this unmet clinical need. Methods: A prospective, observational study of patients activating the Vall d'Hebron University Hospital sepsis code (ISC) within the emergency department (ED), hospital wards and intensive care unit (ICU). Area under the receiver operating characteristic (AUROC) curves, logistic and Cox regression analysis were used to assess performance. Results: 148 patients fulfilled the Vall d'Hebron ISC criteria, of which 130 (87.8%) were retrospectively found to have a confirmed diagnosis of infection. Both PCT and MR-proADM had a moderate-to-high performance in discriminating between infected and non-infected patients following ISC activation, although the optimal PCT cutoff varied significantly across departments. Similarly, MR-proADM and SOFA performed well in predicting 28-and 90-day mortality within the total infected patient population, as well as within patients presenting with a community-acquired infection or following a medical emergency or prior surgical procedure. Importantly, MR-proADM also showed a high association with the requirement for ICU admission after ED presentation [OR (95% CI) 8.18 (1.75-28.33)] or during treatment on the ward [OR (95% CI) 3.64 (1.43-9.29)], although the predictive performance of all biomarkers and clinical scores diminished between both settings. Conclusions: Results suggest that the individual use of PCT and MR-proADM might help to accurately identify patients with infection and assess the overall severity of the host response, respectively. In addition, the use of MR-proADM could accurately identify patients requiring admission onto the ICU, irrespective of whether patients

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“…Changes in serum CRP levels during the first 48 h after antibiotic initiation can help evaluate the response to initial antimicrobial therapy [27]. Likewise, a PCT-based algorithm may help reduce antibiotic exposure in septic patients without compromising clinical outcomes [28,29]. However, not all studies have shown the same positive effect [30], suggesting that the effectiveness of PCT-based algorithms may depend on the physician's experience and the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers of Sepsis: Time for a Reappraisal

Pierrakos

Velissaris

Bisdorff

et al. 2020

Preprint

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Introduction: Sepsis biomarkers can have important diagnostic, therapeutic, and prognostic functions. In a previous review, we identified 3370 references reporting on 178 different biomarkers related to sepsis. In the present review, we evaluate the progress in the research of sepsis biomarkers.Methods: Using the same methodology as in our previous review, we searched the PubMed database from 2009 until September 2019 using the terms "Biomarker" AND "Sepsis". There were no restrictions by age or language and all studies, clinical and experimental, were included. Results:We retrieved a total of 5367 new references since our previous review. We identified 258 biomarkers, 80 of which were new compared to our previous list. The majority of biomarkers have been evaluated in fewer than 5 studies, with 81 (31%) being assessed in just a single study. Apart from studies of C-reactive protein (CRP) or procalcitonin (PCT), only 26 biomarkers have been assessed in clinical studies with more than 300 participants. Forty biomarkers have been compared to PCT and/or C-reactive protein CRP for their diagnostic value; 9 were shown to have a better diagnostic value for sepsis than either or both of these biomarkers. Forty-four biomarkers have been evaluated for a role in answering a specific clinical question rather than for their general diagnostic or prognostic properties in sepsis. Conclusions:The number of biomarkers being identified is still increasing although at a slower rate than in the past. Most of the biomarkers have not been well-studied; in particular the clinical role of these biomarkers needs to be better evaluated.

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Procalcitonin-guided antibiotic therapy in patients with fever in a general emergency department population: a multicentre non-inferiority randomized clinical trial (HiTEMP study)

Cited by 66 publications

References 29 publications

Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

Biomarkers and clinical scores to aid the identification of disease severity and intensive care requirement following activation of an in-hospital sepsis code

Biomarkers of Sepsis: Time for a Reappraisal

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