Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial

Bouadma, Lila; Luyt, Charles‐Édouard; Tubach, Florence; Cracco, Christophe; Alvarez, A.L.; Schwebel, Carole; Schortgen, Frédérique; Lasocki, Sigismond; Veber, Benoît; Dehoux, Monique; Bernard, Maguy; Pasquet, Blandine; Régnier, B.; Brun‐Buisson, Christian; Chastre, Jean; Wolff, Michel

doi:10.1016/s0140-6736(09)61879-1

Cited by 1,017 publications

(969 citation statements)

References 42 publications

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“…We referred to 9 RCT reports during our meta‐analysis on this topic 78, 79, 80, 81, 82, 83, 84, 85, 86. No significant differences were observed between the intervention and control groups with respect to ICU stay time, hospitalization period, 60‐day mortality rate, and 90‐day mortality rate.…”

Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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“…Because vascular occlusion and transmural bowel necrosis were both excluded by radiology and/or endoscopy, AMA was improved by decompression with nasogastric drainage. The patient received antibiotics (meropenem, 1 g every 12 h, which was adjusted to her renal function) with vasopressors and she recovered from shock in approximately 48 h. Meropenem was discontinued in 14 days with improvement of her general condition and serum procalcitonin level (0.40 ng/mL) 5. Repeated upper endoscopy also revealed gradual improvement of the MG (Fig.…”

Section: Figurementioning

confidence: 99%

Superior mesenteric artery syndrome leading to reversible mucosal gangrene

Uemura

Suzuki

Katayama

et al. 2017

Acute Medicine & Surgery

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We describe a case in which gastrointestinal distention due to superior mesenteric artery syndrome (SMAS) developed into membranous gangrene, which in turn led to septic shock in a 60‐year‐old woman with cerebral palsy and cachexia. The association with SMAS and septic shock is considered extremely rare, it is important to consider this combination especially in cachectic patients with gastric distension accompanying refractory shock unknown etiology.

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“…For patients in the PCT group, the absolute difference of 2.7 days between the mean number of days without antibiotics by day 28 corresponded to a 23% relative reduction in antibiotic exposure. The authors did not report any difference in the length of stay in ICU between groups, as well as no difference in mortality and adverse events [7]. In a recent study that we conducted in patients admitted to hospital for severe exacerbations of COPD associated with clinical signs of bacterial infections (increased and purulent sputum and/or respiratory failure), the PCT-guided reduction of duration of antibiotic treatment from 3 to 10 days was not associated with increased risk of exacerbations in the following 6 months [8].…”

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confidence: 91%

“…In a meta-analysis including 14 trials including 4221 patients, the use of PCT to guide initiation and duration of antibiotic treatment in patients with ARIs was found to be effective: antibiotic consumption was significantly reduced across different clinical settings and ARI diagnoses, while its use was not associated with higher mortality rates or treatment failure [6]. Same data were obtained in a multicenter, prospective, parallel-group, open-label trial called PRORATA trial: the PCT-guided strategy to treat suspected bacterial infections in non-surgical patients in intensive care units (ICU) was found to be effective in reducing antibiotic exposure and selective pressure with no apparent adverse outcomes [7]. For patients in the PCT group, the absolute difference of 2.7 days between the mean number of days without antibiotics by day 28 corresponded to a 23% relative reduction in antibiotic exposure.…”

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confidence: 92%

Procalcitonin-guided antibiotic therapy: a potentially effective and efficient strategy

Plebani

Fabbri

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial

Cited by 1,017 publications

References 42 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Superior mesenteric artery syndrome leading to reversible mucosal gangrene

Procalcitonin-guided antibiotic therapy: a potentially effective and efficient strategy

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