[en] Due to overlap of clinical findings and low sensitivity of bacterial diagnostic tests, differentiation between bacterial and viral respiratory tract infections remains challenging, ultimately leading to antibiotic overuse in this population of patients. Addition of procalcitonin, a blood biomarker expressed by epithelial cells in response to bacterial infections, to the clinical assessment leads to a reduction in inappropriate antibiotic initiation. Procalcitonin also provides prognostic information about the resolution of illness, and significant decreases over time are a strong signal for the discontinuation of antibiotics. Current evidence from randomized trials indicates that procalcitonin-guided antibiotic stewardship results in a reduction in antibiotic use and antibiotic side effects, which importantly translates into improved survival of patients with respiratory infections. Inclusion of procalcitonin into antibiotic stewardship algorithms thus improves the diagnostic and therapeutic management of patients presenting with respiratory illnesses and holds great promise to mitigate the global bacterial resistance crisis.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Wirz, Yannick
Branche, Angela
Wolff, Michel
Welte, Tobias
Nobre, Vandack
Reinhart, Konrad
Falsey, Ann R.
DAMAS, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Service des soins intensifs généraux
Musher, D. M. and Thorner, A. R. (2014) Community-acquired pneumonia N. Engl. J. Med. 371 (17) 1619-1628 10.1056/NEJMra1312885
Schuetz, P., Albrich, W., and Mueller, B. (2011) Procalcitonin for diagnosis of infection and guide to antibiotic decisions: Past, present and future BMC Med. 9, 107 10.1186/1741-7015-9-107
Schuetz, P., Christ-Crain, M., and Muller, B. (2009) Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections-hope for hype Swiss Med. Wkly 139 (23-24) 318-326
Sager, R., Kutz, A., Mueller, B., and Schuetz, P. (2017) Procalcitonin-guided diagnosis and antibiotic stewardship revisited BMC Med. 15 (1) 15 10.1186/s12916-017-0795-7
FDA. ((2017) FDA clears test to help manage antibiotic treatment for lower respiratory tract infections and sepsis, https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm543160.htm.
Schuetz, P., Muller, B., and Christ-Crain, M. et al. 2012, Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections Cochrane Database Syst. Rev. 9 (9) CD007498 10.1002/14651858.CD007498.pub2
Schuetz, P., Briel, M., and Christ-Crain, M. et al. 2012, Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: An individual patient data meta-analysis Clin. Infect. Dis. 55 (5) 651-662 10.1093/cid/cis464
Schuetz, P., Wirz, Y., and Sager, R. et al. 2017, Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: A patient level meta-analysis Lancet Infect. Dis. 10.1016/S1473-3099(17)30592-3
Schuetz, P., Wirz, Y., and Sager, R. et al. 2017, Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections Cochrane Database Syst. Rev. 10, CD007498 10.1002/14651858.CD007498.pub3
Schuetz, P., Chiappa, V., Briel, M., and Greenwald, J. L. (2011) Procalcitonin algorithms for antibiotic therapy decisions: A systematic review of randomized controlled trials and recommendations for clinical algorithms Arch. Intern. Med. 171 (15) 1322-1331 10.1001/archinternmed.2011.318
Briel, M., Schuetz, P., and Mueller, B. (2008) Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care Arch. Intern. Med. 168 (18) 2000-2007 10.1001/archinte.168.18.2000
Burkhardt, O., Ewig, S., and Haagen, U. et al. 2010, A simple procalcitonin-guided strategy results in safe reductions of antibiotic use in patients with symptoms of acute respiratory tract infections in primary care Eur. Respir. J. 36, 601 10.1183/09031936.00163309
Garnacho-Montero, J., Gutierrez-Pizarraya, A., and Escoresca-Ortega, A. et al. 2014, De-escalation of empirical therapy is associated with lower mortality in patients with severe sepsis and septic shock Intensive Care Med. 40 (1) 32-40 10.1007/s00134-013-3077-7
Schuetz, P. and Mueller, B. (2014) Biomarker-guided de-escalation of empirical therapy is associated with lower risk for adverse outcomes Intensive Care Med. 40 (1) 141 10.1007/s00134-013-3139-x
Nobre, V., Harbarth, S., Graf, J. D., Rohner, P., and Pugin, J. (2008) Use of procalcitonin to shorten antibiotic treatment duration in septic patients: A randomized trial Am. J. Respir. Crit. Care Med. 177 (5) 498-505 10.1164/rccm.200708-1238OC
Schuetz, P., Birkhahn, R., and Sherwin, R. et al. 2017, Serial Procalcitonin Predicts Mortality in Severe Sepsis Patients: Results From the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study Crit. Care Med. 45 (5) 781-789 10.1097/CCM.0000000000002321
Roberts, R. R., Hota, B., and Ahmad, I. et al. 2009, Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: Implications for antibiotic stewardship Clin. Infect. Dis. 49 (8) 1175-1184 10.1086/605630
Classen, D. C., Jaser, L., and Budnitz, D. S. (2010) Adverse drug events among hospitalized Medicare patients: Epidemiology and national estimates from a new approach to surveillance Jt Comm J. Qual Patient Saf. 36 (1) 12-21 10.1016/S1553-7250(10)36003-X
Schuetz, P., Kutz, A., and Grolimund, E. et al. 2014, Excluding infection through procalcitonin testing improves outcomes of congestive heart failure patients presenting with acute respiratory symptoms: Results from the randomized ProHOSP trial Int. J. Cardiol. 175 (3) 464-472 10.1016/j.ijcard.2014.06.022
Schuetz, P., Daniels, L. B., Kulkarni, P., Anker, S. D., and Mueller, B. (2016) Procalcitonin: A new biomarker for the cardiologist Int. J. Cardiol. 223, 390-397 10.1016/j.ijcard.2016.08.204
Schuetz, P., Balk, R., and Briel, M. et al. 2015, Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: A US health system perspective Clin. Chem. Lab. Med. 53 (4) 583-592 10.1515/cclm-2014-1015
Stojanovic, I., Schneider, J. E., Wei, L., Hong, Z., Keane, C., and Schuetz, P. (2017) Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: A Chinese hospital system perspective Clin. Chem. Lab. Med. 55 (4) 561-570 10.1515/cclm-2016-0349
Lima, S. S., Nobre, V., and de Castro Romanelli, R. M. et al. 2016, Procalcitonin-guided protocol is not useful to manage antibiotic therapy in febrile neutropenia: A randomized controlled trial Ann. Hematol. 95 (7) 1169-1176 10.1007/s00277-016-2639-5
Schuetz, P., Bretscher, C., Bernasconi, L., and Mueller, B. (2017) Overview of procalcitonin assays and procalcitonin-guided protocols for the management of patients with infections and sepsis Expert Rev. Mol. Diagn. 17 (6) 593-601 10.1080/14737159.2017.1324299
Zhydkov, A., Christ-Crain, M., and Thomann, R. et al. 2015, Utility of procalcitonin, C-reactive protein and white blood cells alone and in combination for the prediction of clinical outcomes in community-acquired pneumonia Clin. Chem. Lab. Med. 53 (4) 559-566 10.1515/cclm-2014-0456
Paiva, M. B., Botoni, F. A., Teixeira, A. L., Jr., Miranda, A. S., de Oliveira, C. R. A., AbrahaÌo, J. O., Faria, G. M., and Nobre, V. (2012) The behavior and diagnostic utility of procalcitonin and five other inflammatory molecules in critically ill patients with respiratory distress and suspected 2009 influenza a H1N1 infection Clinics 67 (4) 327-334 10.6061/clinics/2012(04)05
Oliveira, C. F., Botoni, F. A., Oliveira, C. R., Silva, C. B., Pereira, H. A., Serufo, J. C., and Nobre, V. (2013) Procalcitonin versus C-reactive protein for guiding antibiotic therapy in sepsis: A randomized trial Crit. Care Med. 41 (10) 2336-2343 10.1097/CCM.0b013e31828e969f
Whitney, C. G., Farley, M. M., and Hadler, J. et al. 2000, Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States N. Engl. J. Med. 343 (26) 1917-1924 10.1056/NEJM200012283432603
