Procalcitonin for antibiotic treatment in intensive care unit patients.

[en] Procalcitonin (PCT), a 116-aminoacids prohormone, has been substantially studied over the last 2 decades in the field of sepsis. Disappointingly low sensitivity values led to the abandonment of the concept of it as a diagnostic tool and then to its being considered more as a prognostic marker with a good correlation with severe infection. Later on, growing concerns about multidrug-resistant bacteria in the ICU environment and about the cost and side effects of antibiotics suggested that PCT might prove to be a valuable asset in stewardship programs. Numerous but hardly comparable randomized controlled trials assessing either initiation or deescalation in ICU patients have been published. Stewardship encompassing PCT should focus on the latter, because of the high negative predictive value of this biomarker. However, there still would be safety concerns if a systematic implementation of PCT were to be considered in daily stewardship programs in the ICU, especially in extra-thoracic sepsis.

Disciplines :

Anesthesia & intensive care
General & internal medicine

Author, co-author :

LAYIOS, Nathalie ; Centre Hospitalier Universitaire de Liège - CHU > Soins intensifs

LAMBERMONT, Bernard ; Centre Hospitalier Universitaire de Liège - CHU > Frais communs médecine

Language :

English

Title :

Procalcitonin for antibiotic treatment in intensive care unit patients.

Publication date :

2013

Journal title :

Current Infectious Disease Reports

ISSN :

1523-3847

eISSN :

1534-3146

Publisher :

Current Science, United States

Volume :

Issue :

Pages :

394-9

Peer reviewed :

Peer reviewed

Available on ORBi :

since 07 October 2014

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280 (4 by ULiège)

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Bibliography

Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341:515-8.
Carvalhaes CG, Cayô R, Gales AC. Klebsiella pneumoniae Carbapenemase-Producing Klebsiella Pneumoniae in the Intensive Care Unit: A Real Challenge to Physicians, Scientific Community, and Society. Shock. 2013;39 Suppl 1:32-7.
Giuffrè M, Cipolla D, Bonura C, et al. Outbreak of colonizations by extended-spectrum β-lactamase-producing Escherichia coli sequence type 131 in a neonatal intensive care unit, Italy. Antimicrob Resist Infect Control. 2013;2:8.
• Hausfater P, Garric S, Ayed SB, et al. Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: a prospective study. Clin Infect Dis. 2002;34:895-901. Procalcitonin as a diagnostic tool in sepsis.
d'Escrivan T, Kipnis E, Robriquet L. Assessment of procalcitonin levels in emergency department patients. Clin Infect Dis. 2002;35:1275-6. author reply 1276.
Ugarte H, Silva E, Mercan D, et al. Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med. 1999;27:498-504.
Vincent JL. Procalcitonin: THE marker of sepsis? Crit Care Med. 2000;28:1226-8.
Chan YL, Tseng CP, Tsay PK, et al. Procalcitonin as a marker of bacterial infection in the emergency department: an observational study. Crit Care. 2004;8:R12-20.
• Jensen JU, Heslet L, Jensen TH, et al. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med. 2006;34:2596-602. Procalcitonin as a prognostic tool.
• Jensen JU, Hein L, Lundgren B, et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Crit Care Med. 2011;39:2048-58. Largest, negative, ICU trial.
Layios N, Damas P. The authors reply. Crit Care Med. 2013;41:e28.
•• Foushee JA, Hope NH, Grace EE. Applying biomarkers to clinical practice: a guide for utilizing procalcitonin assays. J Antimicrob Chemother. 2012;67:2560-9. Good review of procalcitonin physiopathology and clinical findings.
Brodska H, Drabek T, Malickova K, et al. Marked increase of procalcitonin after the administration of anti-thymocyte globulin in patients before hematopoietic stem cell transplantation does not indicate sepsis: a prospective study. Crit Care. 2009;13:R37.
Christ-Crain M, Morgenthaler NG, Stolz D, et al. Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia. Crit Care. 2006;10(3):R96.
Stolz D, Christ-Crain M, Bingisser R, et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest. 2007;131:9-19.
Kofoed K, Andersen O, Kronborg G, et al. Use of plasma C-reactive protein, procalcitonin, neutrophils, macrophage migration inhibitory factor, soluble urokinase-type plasminogen activator receptor, and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections: a prospective study. Crit Care. 2007;11:R38.
Huang DT, Weissfeld LA, Kellum JA, et al. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med. 2008;52:48-58. e2.
Viallon A, Guyomarc'h S, Marjollet O, et al. Can emergency physicians identify a high mortality subgroup of patients with sepsis: role of procalcitonin. Eur J Emerg Med. 2008;15:26-33.
Müller F, Christ-Crain M, Bregenzer T, et al. Procalcitonin levels predict bacteremia in patients with community-acquired pneumonia: a prospective cohort trial. Chest. 2010;138:121-9.
Carrol ED, Thomson AP, Hart CA. Procalcitonin as a marker of sepsis. Int J Antimicrob Agents. 2002;20:1-9.
Bloos F, Marshall JC, Dellinger RP, et al. Multinational, observational study of procalcitonin in ICU patients with pneumonia requiring mechanical ventilation: a multicenter observational study. Crit Care. 2011;15:R88.
Hausfater P, Juillien G, Madonna-Py B, et al. Serum procalcitonin measurement as diagnostic and prognostic marker in febrile adult patients presenting to the emergency department. Crit Care. 2007;11(3):R60.
Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet. 2004;363:600-7.
Simon L, Gauvin F, Amre DK, et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004;39:206-17.
•• Nobre V, Harbarth S, Graf JD, et al. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med. 2008;177:498-505. First ICU RCT evaluating de-escalation.
Gleckman RA, Czachor JS. Antibiotic side effects. Semin Respir Crit Care Med. 2000;21:53-60.
Granowitz EV, Brown RB. Antibiotic adverse reactions and drug interactions. Crit Care Clin. 2008;24:421-42.
Becker KL, Nylén ES, White JC, et al. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004;89:1512-25.
Gilbert DN. Use of plasma procalcitonin levels as an adjunct to clinical microbiology. J Clin Microbiol. 2010;48:2325-9.
Layios N, Lambermont B, Canivet JL, et al. Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients. Crit Care Med. 2012;40:2304-9.
Menéndez R, Sahuqillo-Arcoe JM, Reyes S, et al. Cytokine activation patterns and biomarkers Are influenced by microorganisms in community-acquired pneumonia. Chest. 2012;141(6):1537-45.
• Heyland DK, Johnson AP, Reynolds SC, et al. Procalcitonin for reduced antibiotic exposure in the critical care setting: a systematic review and an economic evaluation. Crit Care Med. 2011;39:1792-9. Cost-effectiveness positive trial.
Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010;375:463-74.
Stolz D, Smyrnios N, Eggimann P, et al. Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study. Eur Respir J. 2009;34:1364-75.
Brunkhorst FM, Heinz U, Forycki ZF. Kinetics of procalcitonin in iatrogenic sepsis. Intensive Care Med. 1998;24:888-9.
Christ-Crain M, Opal SM. Clinical review: the role of biomarkers in the diagnosis and management of community-acquired pneumonia. Crit Care. 2010;14:203.
Johansen ME, Jensen JU, Lundgren JD. Antibiotics in intensive care: too little or too much? Crit Care Med. 2011;39:1849-51.
Hayashi Y, Paterson DL. Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin Infect Dis. 2011;52:1232-40.
• Matthaiou DK, Ntani G, Kontogiorgi M, et al. An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic therapy algorithms in adult critically ill patients. Intensive Care Med. 2012;38:940-9. ESICM (positive) meta-analysis.
Schuetz P, Briel M, Christ-Crain M, et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis. Clin Infect Dis. 2012;55:651-62.
•• Schuetz P, Chiappa V, Briel M, et al. Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med. 2011;171:1322-31. Positive review of randomized controlled trials investigating procalcitonin to desescalade antibiotics in primary and acute care settings.
Annane D, Maxime V, Faller JP, et al. Procalcitonin levels to guide antibiotic therapy in adults with non-microbiologically proven apparent severe sepsis: a randomised controlled trial. BMJ Open. 2013;3(2).
Póvoa P, Salluh JI. Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review. Ann Intensive Care. 2012;2:32.
Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections-full version. Clin Microbiol Infect. 2011;17 Suppl 6:E1-59.
Assink-de Jong E, de Lange DW, van Oers JA, et al. Stop Antibiotics on guidance of Procalcitonin Study (SAPS): a randomised prospective multicenter investigator-initiated trial to analyse whether daily measurements of procalcitonin versus a standard-of-care approach can safely shorten antibiotic duration in intensive care unit patients - calculated sample size: 1816 patients. BMC Infect Dis. 2013;13:178.
Murray PR, Masur H. Current approaches to the diagnosis of bacterial and fungal bloodstream infections in the intensive care unit. Crit Care Med. 2012;40:3277-82.
• Gibot S, Béné MC, Noel R, et al. Combination biomarkers to diagnose sepsis in the critically ill patient. Am J Respir Crit Care Med. 2012;186:65-71. First bioscore to include individual phenotypic data and PCT.
Schroeder S, Hochreiter M, Koehler T, et al. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Langenbecks Arch Surg. 2009;394(2):221-6.
Hochreiter M, Köhler T, Schweiger AM, et al. Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial. Crit Care. 2009;13(3):R83.
Argawal R, Schwartz D. Procalcitonin to guide duration of antimicrobial therapy in Intensive Care Units. Clin Infect Dis. 2011;53:379-87.
Hohn A, Schroeder S, Gehrt A, et al. Procalcitonin-guided algorithm to reduce length of antibiotic therapy in patients with severe sepsis and septic shock. BMC Infect Dis. 2013;13:158.