Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections

Abstract

Use of procalcitonin to guide initiation and duration of antibiotic treatment in patients with ARI was not associated with higher mortality rates or treatment failure. Antibiotic consumption was significantly reduced across different clinical settings and ARI diagnoses. Further high-quality research is needed to confirm the safety of this approach for non-European countries and patients in intensive care. Moreover, future studies should also establish cost-effectiveness by considering country-specific costs of procalcitonin measurement and potential savings in consumption of antibiotics and other healthcare resources, as well as secondary cost savings due to lower risk of side effects and reduced antimicrobial resistance.

Procalcitonin Uptake and Effect on Antibiotics Stewardship: A Single Institution Experience

“…In both the chi squared analysis and logistic regression analyses ordering a procalcitonin test was not associated with number of antibiotics used, duration of antibiotic use and type of diagnosis (SEPSIS or COPD). This finding differs from some studies that showed that procalcitonin reduced the number and duration of antibiotics use [26][27][28][29][30][31][32] . However, similar to our finding, a few studies did not show a difference in antibiotics use in procalcitonin guided therapy [33] .…”

Procalcitonin Uptake and Effect on Antibiotics Stewardship: A Single Institution Experience

“…In both the chi squared analysis and logistic regression analyses ordering a procalcitonin test was not associated with number of antibiotics used, duration of antibiotic use and type of diagnosis (SEPSIS or COPD). This finding differs from some studies that showed that procalcitonin reduced the number and duration of antibiotics use [26][27][28][29][30][31][32] . However, similar to our finding, a few studies did not show a difference in antibiotics use in procalcitonin guided therapy [33] .…”

Clinical effectiveness of procalcitonin‐ or C‐reactive protein‐guided antibiotic discontinuation protocols for adult patients who are critically ill with sepsis: a rapid systematic review and meta‐analysis

“…This finding aligns with some previous review findings [64,67]. Potential explanations may be that clinicians in high-acuity settings are generally less willing to adhere to PCT algorithms or there is more caution in antibiotic discontinuation in patients perceived as more seriously ill [69]. Whilst these findings are from a meta-regression and need to be treated with caution given their observational nature [70], they highlight the importance of considering how clinical judgement and PCT-guided protocols are intercalated in decision-making during implementation activities.…”

Multidimensional Assessment of the Host Response in Mechanically Ventilated Patients with Suspected Pneumonia

“…In both of our prospective cohorts, BAL neutrophilia outperformed procalcitonin, a peripheral blood biomarker used to help discriminate bacterial from nonbacterial infection (28). This observation is concordant with recent work demonstrating that disease-specific host response signatures are superior to systemic markers of inflammation (39).…”

Procalcitonin Uptake and Effect on Antibiotics Stewardship: A Single Institution Experience

“…In both the chi squared analysis and logistic regression analyses ordering a procalcitonin test was not associated with number of antibiotics used, duration of antibiotic use and type of diagnosis (SEPSIS or COPD). This finding differs from some studies that showed that procalcitonin reduced the number and duration of antibiotics use [26][27][28][29][30][31][32] . However, similar to our finding, a few studies did not show a difference in antibiotics use in procalcitonin guided therapy [33] .…”

Clinical effectiveness of procalcitonin‐ or C‐reactive protein‐guided antibiotic discontinuation protocols for adult patients who are critically ill with sepsis: a rapid systematic review and meta‐analysis

“…This finding aligns with some previous review findings [64,67]. Potential explanations may be that clinicians in high-acuity settings are generally less willing to adhere to PCT algorithms or there is more caution in antibiotic discontinuation in patients perceived as more seriously ill [69]. Whilst these findings are from a meta-regression and need to be treated with caution given their observational nature [70], they highlight the importance of considering how clinical judgement and PCT-guided protocols are intercalated in decision-making during implementation activities.…”

Multidimensional Assessment of the Host Response in Mechanically Ventilated Patients with Suspected Pneumonia

“…In both of our prospective cohorts, BAL neutrophilia outperformed procalcitonin, a peripheral blood biomarker used to help discriminate bacterial from nonbacterial infection (28). This observation is concordant with recent work demonstrating that disease-specific host response signatures are superior to systemic markers of inflammation (39).…”

Procalcitonin Uptake and Effect on Antibiotics Stewardship: A Single Institution Experience

“…In both the chi squared analysis and logistic regression analyses ordering a procalcitonin test was not associated with number of antibiotics used, duration of antibiotic use and type of diagnosis (SEPSIS or COPD). This finding differs from some studies that showed that procalcitonin reduced the number and duration of antibiotics use [26][27][28][29][30][31][32] . However, similar to our finding, a few studies did not show a difference in antibiotics use in procalcitonin guided therapy [33] .…”

Clinical effectiveness of procalcitonin‐ or C‐reactive protein‐guided antibiotic discontinuation protocols for adult patients who are critically ill with sepsis: a rapid systematic review and meta‐analysis

“…This finding aligns with some previous review findings [64,67]. Potential explanations may be that clinicians in high-acuity settings are generally less willing to adhere to PCT algorithms or there is more caution in antibiotic discontinuation in patients perceived as more seriously ill [69]. Whilst these findings are from a meta-regression and need to be treated with caution given their observational nature [70], they highlight the importance of considering how clinical judgement and PCT-guided protocols are intercalated in decision-making during implementation activities.…”

Multidimensional Assessment of the Host Response in Mechanically Ventilated Patients with Suspected Pneumonia

“…In both of our prospective cohorts, BAL neutrophilia outperformed procalcitonin, a peripheral blood biomarker used to help discriminate bacterial from nonbacterial infection (28). This observation is concordant with recent work demonstrating that disease-specific host response signatures are superior to systemic markers of inflammation (39).…”