Use of a Procalcitonin-guided Antibiotic Treatment Algorithm in the Pediatric Intensive Care Unit

Katz, Sophie; Crook, Jennifer; Gillon, Jessica; Stanford, J Eric; Wang, Li; Colby, Jennifer M.; Banerjee, Ritu

doi:10.1097/inf.0000000000002986

Cited by 8 publications

(17 citation statements)

References 19 publications

(28 reference statements)

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“…The results of a randomized prospective trial in PICU patients did not confirm the reduction of antibiotic treatment duration as previously described. 44 One difference to other studies was the integration of Antibiotic Stewardship recommendations in both study arms (PCT and usual care). This might have led to shorter antibiotic courses per se (at mean 6 days).…”

Section: Role Of Biomarkers In Guiding Antibiotic Therapymentioning

confidence: 99%

Antibiotics in critically ill children—a narrative review on different aspects of a rational approach

Bruns

Dohna-Schwake

2021

Pediatr Res

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Especially critically ill children are exposed to antibiotic overtreatment, mainly caused by the fear of missing out a severe bacterial infection. Potential adverse effects and selection of multi-drug resistant bacteria play minor roles in decision making. This narrative review first describes harm from antibiotics and second focuses on different aspects that could help to reduce antibiotic overtreatment without harming the patient: harm from antibiotic treatment, diagnostic approaches, role of biomarkers, timing of antibiotic therapy, empiric therapy, targeted therapy, and therapeutic drug monitoring. Wherever possible, we linked the described evidence to the current Surviving Sepsis Campaign guidelines. Antibiotic stewardship programs should help guiding antibiotic therapy for critically ill children. Impact Critically ill children can be harmed by inadequate or overuse of antibiotics. Hemodynamically unstable children with a suspicion of infection should be immediately treated with broad-spectrum antibiotics. In contrast, in hemodynamically stable children with sepsis and organ dysfunction, a time frame of 3 h for proper diagnostics may be adequate before starting antibiotics if necessary. Less and more targeted antibiotic treatment can be achieved via antibiotic stewardship programs.

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Section: Role Of Biomarkers In Guiding Antibiotic Therapymentioning

confidence: 99%

Antibiotics in critically ill children—a narrative review on different aspects of a rational approach

Bruns

Dohna-Schwake

2021

Pediatr Res

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“…(2) Secondary outcome: duration of antibiotic therapy, hospitalization, duration of hospital stay, antibiotic side effects Katz (Katz et al, 2021) RCT (1) 270 pediatrics, aged >7 day-18 years;…”

Section: Secondary Endpointsmentioning

confidence: 99%

“…Trial sequential analysis. Dai et al, 2015;Katz et al, 2021) and two neonatal (Lee et al, 2020;Su et al, 2022) RCTs. The ProPAED trial enrolled 337 subjects with LRTIs and divided them randomly into two groups: the PCT-guided antibiotic management group (n = 168) and the usual care group (n = 169).…”

Section: Figurementioning

confidence: 99%

Procalcitonin-guided antibiotic therapy for pediatrics with infective disease: A updated meta-analyses and trial sequential analysis

Liu

2022

Front. Cell. Infect. Microbiol.

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ObjectiveWe aimed to evaluate the effect of procalcitonin (PCT) guided therapy on antibiotic exposure in pediatric patients with infectious disease.MethodsWe performed an updated systematic review and meta-analysis of randomized controlled trials (RCTs) identified in systematic searches of MEDLINE, Embase, the Cochrane Database, Google Scholar, and SinoMed (through July 2021). The primary outcome was the length of the antibiotic therapy. Required information size (RIS) was calculated using trial sequential analysis (TSA).ResultsFour RCTs with 1,313 patients with infectious disease were included. Overall, after a mean 22-day follow-up, PCT-guided antibiotic therapy was associated with a significantly shorter length of antibiotic therapy compared with the control group (WMD, −2.22 days; 95% CI, −3.41 to −1.03; P <0.001) and a decreased rate of antibiotic adverse events (RR, 0.25; 95% CI, 0.11–0.58; P <0.001). However, the length of hospital stay (WMD, −0.39 days; 95% CI, −0.84 to 0.07; P = 0.094), rates of antibiotic prescription (RR, 1.10; 95% CI, 0.97–1.25; P = 0.122), hospital readmission (RR, 1.03; 95% CI, 0.92–1.16; P = 0.613) and mortality (RR, 0.73; 95% CI, 0.17–3.19; P = 0.674) were comparable between the PCT-guided antibiotic and control groups. TSA showed that the RIS was 2,340, indicating a statistically significantly shorter length of antibiotic therapy between PCT-guided antibiotic and control groups (P <0.05).ConclusionsPCT-guided management seems to be able to decrease antibiotic exposure in patients with infectious disease. However, much larger prospective clinical studies are warranted to confirm these findings.

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“…In the ProPICU trial, only 38% of patients had all four serial PCT levels drawn per protocol. 18 The role of PCT used in conjunction with widely available rapid molecular viral diagnostics must be assessed. PCT may add incremental, if any benefit, beyond viral detection, especially with increasing provider awareness of the importance of antibiotic stewardship and reducing unnecessary antibiotic use for patients with viral infections.…”

mentioning

confidence: 99%

“…Pairing PCT testing with oversight by an antibiotic stewardship programme shows promise for increasing compliance with treatment algorithms, but this requires multidisciplinary collaboration and personnel which are not always feasible in all settings. 18 …”

mentioning

confidence: 99%

CON: Procalcitonin does not have clinical utility in children with community-acquired pneumonia

Banerjee

2021

JAC-Antimicrobial Resistance

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Most clinical studies supporting procalcitonin (PCT)-guided management of lower respiratory tract infections have been performed in adults. There is a paucity of studies evaluating the clinical impact of PCT use in children and limited data informing age-appropriate PCT cut-offs; diagnostic accuracy in immunocompromised children; patient subgroups most likely to benefit from PCT testing; whether PCT adds value beyond available rapid molecular viral diagnostics; and optimal implementation strategies for PCT-guided treatment. At the present time there is little evidence to support routine use of PCT to aid management of paediatric pneumonia.

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Use of a Procalcitonin-guided Antibiotic Treatment Algorithm in the Pediatric Intensive Care Unit

Cited by 8 publications

References 19 publications

Antibiotics in critically ill children—a narrative review on different aspects of a rational approach

Antibiotics in critically ill children—a narrative review on different aspects of a rational approach

Procalcitonin-guided antibiotic therapy for pediatrics with infective disease: A updated meta-analyses and trial sequential analysis

CON: Procalcitonin does not have clinical utility in children with community-acquired pneumonia

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