Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease

Abstract

Acute chest syndrome (ACS) is a major complication of sickle-cell disease. Bacterial infection is one cause of ACS, so current guidelines recommend the routine use of antibiotics. We performed a prospective before–after study in medical wards and an intensive-care unit (ICU). During the control phase, clinicians were blinded to procalcitonin concentration results. We built an algorithm using the obtained measurements to hasten antibiotic cessation after three days of treatment if bacterial infection was not documented, and procalcitonin concentrations were all <0.5 μg/L. During the intervention period, the procalcitonin algorithm was suggested to physicians as a guide for antibiotic therapy. The primary endpoint was the number of days alive without antibiotics at Day 21. One-hundred patients were analyzed (103 ACS episodes, 60 in intervention phase). Possible or proven lung infection was diagnosed during 13% of all ACS episodes. The number of days alive without antibiotics at Day 21 was higher during the intervention phase: 15 [14–18] vs. 13 [13,14] days (p = 0.001). More patients had a short (≤3 days) antibiotic course during intervention phase: 31% vs 9% (p = 0.01). There was neither infection relapse nor pulmonary superinfection in the entire cohort. A procalcitonin-guided strategy to prescribe antibiotics in patients with ACS may reduce antibiotic exposure with no apparent adverse outcomes.

Infectious aetiologies of severe acute chest syndrome in sickle-cell adult patients, combining conventional microbiological tests and respiratory multiplex PCR

“…Unfortunately, we did not systematically perform blood measures of procalcitonin or CRP. A recent prospective before–after study in medical wards and ICU aimed at assessing the usefulness of procalcitonin to reduce antibiotics exposure during ACS in adult patients with SCD, and suggested that a procalcitonin-guided strategy might reduce antibiotics exposure with no apparent adverse outcomes 13 .…”

Decreased risk of underdosing with continuous infusion versus intermittent administration of cefotaxime in patients with sickle cell disease and acute chest syndrome

“…In previous studies in SCD patients, the incidence of documented bacterial infections was low, which is consistent with our results. This low incidence of bacterial infection cannot be used to totally question the liberal use of antibiotics in case of ACS with fever [1], although procalcitonin may help shorten the antibiotic course [18]. SCD complicated by an ACS exposes to augmented renal clearance, leading to a high risk of underdosing treatment, especially ß-lactams.…”