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Procalcitonin to guide duration of antimicrobial therapy in intensive care units: a systematic review

Can the use of serum procalcitonin levels safely reduce antimicrobial use in intensive care unit (ICU) patients? We performed a systematic literature review that identified 6 published randomized controlled trials comparing PCT-guided antimicrobial therapy to usual care in ICU patients, extracting data on ICU and patient characteristics, PCT guideline content, intensity of antimicrobial exposure, ICU length of stay, infection relapse, and mortality. Procalcitonin guidance was associated with significantly reduced antimicrobial exposure (effect sizes, 19.5%-38%) in all 5 studies assessing its impact on treatment duration but did not significantly impact antimicrobial exposure in the study assessing treatment initiation only. Length of ICU stay was significantly decreased in 2 studies but was unchanged in the others. Neither infection relapse nor mortality varied significantly in any of the studies. Procalcitonin guidance of antimicrobial duration appears to decrease antimicrobial use in the ICU safely and significantly and may also decrease the length of stay in the ICU.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Is serum procalcitonin able to predict long-term kidney morbidity from urinary tract infections in children?

A new diagnostic strategy for children with febrile urinary tract infections could be the routine use of procalcitonin assessment to identify children requiring closer follow-up since being at risk for kidney damage. A total of 11 studies were published between 1998 and 2007. Children with very high procalcitonin levels during urinary tract infections are likely to be at risk of renal damage and vesico-ureteral reflux. Therefore, the prediction of long-term renal damage showed contradictory results. However, high procalcitonin values at diagnosis and positive scintigraphic scans may suggest the need to investigate for vesico-ureteral reflux. Consequently, procalcitonin levels should be included in follow-up protocols for urinary tract infections to aid in decision making concerning scintigraphic scans and voiding cystourethrograms.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Use of serum procalcitonin to detect bacterial infection in patients with autoimmune diseases: a systematic review and meta-analysis

OBJECTIVE: To systematically review evidence of the accuracy of the procalcitonin test for diagnosis of bacterial infection in patients with autoimmune disease.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis

OBJECTIVE: To quantify the accuracy of serum procalcitonin as a diagnostic test for sepsis, severe sepsis, or septic shock in adults in intensive care units or after surgery or trauma, alone and compared with C-reactive protein. To draw and compare the summary receiver operating characteristics curves for procalcitonin and C-reactive protein from the literature.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock: a systematic review and meta-analysis

INTRODUCTION: Procalcitonin (PCT) algorithms for antibiotic treatment decisions have been studied in adult patients from primary care, emergency department, and intensive care unit (ICU) settings, suggesting that procalcitonin-guided therapy may reduce antibiotic exposure without increasing the mortality rate. However, information on the efficacy and safety of this approach in the most vulnerable population of critically ill patients with severe sepsis and septic shock is missing.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Procalcitonin-guided algorithms of antibiotic therapy in community-acquired lower respiratory tract infections: a systematic review and meta-analysis of randomized controlled trials]. [Review] [Chinese]

OBJECTIVE: The aim of this study was to evaluate the efficacy and safety of procalcitonin-guided algorithms of antibiotic therapy in lower respiratory tract infections.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

A surgeon's guide to advances in the pharmacological management of acute Charcot neuroarthropathy

Acute Charcot neuroarthropathy is a devastating condition and, its incidence is increasing. Currently, treatment consists of immobilisation and off-loading of the involved extremity. Outcomes are frequently poor and novel treatments are being sought urgently. This review aims to outline advances in the pharmacological treatment of this, condition. PubMed and the Cochrane Database of systematic reviews were searched. Relevant papers were cross referenced. Eleven original studies were identified. The limited data available suggest pamidronate, alendronate and calcitonin provide some clinical and biochemical improvements while zoledronic acid is deleterious and, increases off-loading times. However, the data is not robust enough to convincingly demonstrate clinically meaningful effects. The studies were predominantly low quality and heterogeneous. They differed markedly in study type, pharmacological agent used, dosing regimen, disease, aetiology/stage/location, concurrent off-loading regimen, outcomes and, follow-up. Few were rigorous in controlling for associated confounding variables and none investigated long term outcomes. The routine use of pharmacological treatment modalities for this condition is not recommended in the United States by the Food and Drug Administration or in the United Kingdom by the National Institute for Health and Clinical Excellence. Given the evidence available this is justified and further higher quality research is required.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Therapeutic effects and safety of olcegepant and telcagepant for migraine: a meta-analysis

OBJECTIVE: To evaluate the therapeutic effects and adverse reactions of olcegepant and telcagepant for the treatment of migraine.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Role of plasma procalcitonin in the diagnosis of ventilator-associated pneumonia: systematic review and metaanalysis

OBJECTIVE: To determine the role of plasma procalcitonin (PCT) levels in diagnosing ventilator-associated pneumonia.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Diagnostic value of procalcitonin for bacterial infection in elderly patients – a systematic review and meta-analysis

OBJECTIVE: To summarise evidence for the diagnostic accuracy of procalcitonin (PCT) tests for identifying systemic bacterial infections in elderly patients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Pulpal reactions to orthodontic force application in humans: a systematic review

INTRODUCTION: Force application to a tooth during orthodontic treatment evokes a biological response of the dental pulp. The aim of this systematic literature review was to investigate the relationship between orthodontic force level and pulp reaction in humans.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Value of serum procalcitonin levels in predicting spontaneous bacterial peritonitis

BACKGROUND/AIMS: Spontaneous bacterial peritonitis (SBP) is a life-threatening disease that poses a great diagnostic challenge to clinicians. We aimed to systemically and quantitatively summarize the current evidence on the diagnostic value of the procalcitonin (PCT) test in identifying SBP.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

The use of procalcitonin in the diagnosis of bone and joint infection: a systemic review and meta-analysis

Only a few studies have investigated the use of PCT in the diagnosis of bone and joint infection, and these studies have had relatively small sample sizes. We performed a systematic review and meta-analysis of the diagnostic performance of serum procalcitonin (PCT) in the identification of osteomyelitis and septic arthritis in patients who present with fever and orthopedic symptoms. EMBASE, MEDLINE, and Cochrane databases and the reference lists of relevant articles were searched, with no language restrictions, through February 2012. All original studies that reported the use of serum PCT alone or in comparison with other biomarkers for diagnosis of osteomyelitis and septic arthritis were included. Seven studies qualified for inclusion. These studies enrolled a total of 583 patients with suspected bone or joint infection, 131 of whom had confirmed osteomyelitis or septic arthritis. Analysis of the PCT data indicated a bivariate pooled sensitivity of 0.67 (95 % CI: 0.37-0.88), specificity of 0.90 (95 % CI: 0.78-0.96), a positive likelihood ratio (LR+) of 6.48 (95 % CI: 2.28-14.6), and a negative likelihood ratio (LR-) of 0.37 (95 % CI: 0.16-0.84). Use of a lower PCT cut-off value (0.2-0.3 ng/mL) improved the LR + to 6.66 and the LR- to 0.15. Analysis of the three studies that also measured serum C-reactive protein (CRP) indicated that CRP had an LR + of 1.39 (95 % CI: 1.17-1.65) and an LR- of 0.40 (95 % CI: 0.12-1.36). Our results indicate that PCT may be more suitable as an aid for rule-in diagnosis rather than for exclusion of septic arthritis or osteomyelitis and that use of a lower cut-off value for serum PCT may improve its diagnostic performance.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Can procalcitonin tests aid in identifying bacterial infections associated with influenza pneumonia? A systematic review and meta-analysis

OBJECTIVE: To summarize evidence for the diagnostic accuracy of procalcitonin (PCT) tests for identifying secondary bacterial infections in patients with influenza.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Diagnostic value of serum procalcitonin in patients with chronic renal insufficiency: a systematic review and meta-analysis

BACKGROUND: The diagnostic value of procalcitonin (PCT) for patients with renal impairment is unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin, C-reactive protein and white blood cell count for suspected acute appendicitis

BACKGROUND: The aim was to evaluate the diagnostic value of procalcitonin, C-reactive protein (CRP) and white blood cell count (WBC) in uncomplicated or complicated appendicitis by means of a systematic review and meta-analysis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Meta-analysis and systematic review of procalcitonin-guided therapy in respiratory tract infections

Circulating procalcitonin (PCT) is a biomarker that can be used in diagnosing bacterial infections. We performed a quantitative meta-analysis of available randomized controlled trials to determine whether antibiotic therapy based on PCT measurements alters clinical outcomes and antibiotic use in patients with lower respiratory tract infections. We identified studies through MEDLINE (1996 to 2010), the ISI Web of Knowledge (1996 to 2010), and Ovid. Studies that met our criteria were prospective, randomized controlled trials involving patients with respiratory tract infections. Outcomes of mortality, intensive care unit (ICU) admission, length of hospital stay, number of antibiotic prescriptions, and duration of antibiotic treatment were evaluated. Eight studies randomizing 3,431 patients met our criteria for inclusion. Pooled analysis showed a significant reduction in number of antibiotic prescriptions and duration of antibiotic use in patients with PCT-guided antibiotic treatment compared to standard therapy. In addition, the use of PCT-guided antibiotic therapy did not impact mortality, ICU admission, or length of hospital stay in these studies. A high degree of heterogeneity was identified in 3 of 5 outcomes that were evaluated, and sensitivity analysis indicated that heterogeneity was decreased among studies using the same PCT-based treatment algorithm. In conclusion, PCT-guided antibiotic therapy in patients with respiratory tract infections appears to reduce antibiotic use without affecting overall mortality or length of stay in the hospital.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

The use of pleural fluid procalcitonin and C-reactive protein in the diagnosis of parapneumonic pleural effusions: a systemic review and meta-analysis

BACKGROUND: We aimed to perform a systematic review and meta-analysis of the diagnostic performance of pleural fluid procalcitonin (PCT) or C-reactive protein (CRP) in differentiating parapneumonic effusion in patients with pleural effusion.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Role of procalcitonin in the diagnosis of severe infection in pediatric patients with fever and neutropenia: a systematic review and meta-analysis

OBJECTIVE: The aim of this study was to determine the accuracy of the procalcitonin (PCT) test for diagnosis of bacterial sepsis in pediatric cancer patients with febrile neutropenia.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Value of procalcitonin in diagnosing ventilator-associated pneumonia: a systematic review

Bibliographic details: Liao XL, Deng YY, Kang Y.  Value of procalcitonin in diagnosing ventilator-associated pneumonia: a systematic review. Chinese Journal of Evidence-Based Medicine 2010; 10(8): 910-915 Available from: http://www.cjebm.org.cn/en/oa/DArticle.aspx?type=view&id=20100808

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

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