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Clin Chem Lab Med. 2019 Aug 27;57(9):1308-1318. doi: 10.1515/cclm-2018-1181.

Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use.

Author information

1
Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
2
University of Basel, Basel, Switzerland, Phone: +41 (0) 79 365 10 06, Fax: 41 (0) 62 838 9524.
3
Medisch Spectrum Twente, Enschede, The Netherlands.
4
Five Rivers Medical Center, Pocahontas, AR, USA.
5
Department of Intensive Care. Shock, Organ Dysfunction and Resuscitation Research Group, Vall d'Hebron University Hospital, Barcelona, Spain.
6
University Clinics of Geriatrics, University Hospital of Grenoble-Alpes, GREPI EA7408 University of Grenoble Alpes, Grenoble, France.
7
Swedish Covenant Hospital, Chicago, IL, USA.
8
Emergency Department, Hospital Clinico San Carlos, Madrid, Spain.
9
Respiratory Medicine Section, Department of Internal Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark.
10
CHIP & PERSIMUNE, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
11
University of Pécs, Clinical Centre, Pécs, Hungary.
12
Singapore General Hospital, Singapore, Singapore; Emerging Infectious Diseases Program, Duke-National University of Singapore Medical School, Singapore, Singapore.
13
Florence-Nightingale-Krankenhaus, Kaiserswerther Diakonie, Düsseldorf, Germany.
14
Clinic for Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Düsseldorf, Germany.
15
Service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
16
Klinik für Notfall- und Internistische Intensivmedizin, Klinikum Ernst von Bergmann, Potsdam, Germany.
17
Azienda Ospedaliera-Universitata di Padova, Padua, Italy.
18
Severe Sepsis Center, Scientific Research Institute of Emergency, St. Petersburg, Russian Federation.
19
North-West University-Mechnikov, St. Petersburg, Russian Federation.
20
Department for Health of the Tuscany Region, Clinical Risk Management and Patient Safety Centre of Tuscany Region, Florence, Italy.
21
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
22
University of Hannover, Hannover Medical School, Hannover, Germany; and Member of the German Center of Lung Research.
23
Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester and Basingstoke, UK.
24
University of Southampton, School of Medicine, Southampton, UK.

Abstract

Background Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. Results The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the fixed cut-offs to only one for mild to moderate and one for severe disease (0.25 μg/L and 0.5 μg/L, respectively). Further, guidance on interpretation of PCT results to initiate, withhold or discontinue ABx treatment was included. Conclusions A combination of clinical patient assessment with PCT levels in well-defined ABS algorithms, in context with continuous education and regular feedback to all ABS stakeholders, has the potential to improve the diagnostic and therapeutic management of patients suspected of bacterial infection, thereby improving ABS effectiveness.

KEYWORDS:

ABx stewardship; bacterial infection; biomarker; procalcitonin; respiratory tract infections; sepsis

PMID:
30721141
DOI:
10.1515/cclm-2018-1181

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