The Experts below are selected from a list of 13404 Experts worldwide ranked by ideXlab platform
Beat Muller - One of the best experts on this subject based on the ideXlab platform.
-
Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections hope for hype
Swiss Medical Weekly, 2009Co-Authors: Philipp Schuetz, Mirjam Christcrain, Beat MullerAbstract:This review aims to provide physicians with an overview of the potential of Procalcitonin to guide antibiotic therapy in respiratory tract infections and in sepsis. Knowledge of the strengths and weaknesses of Procalcitonin are prerequisites for a rational and safe use in clinical routine. In most infections a true gold standard for diagnosis does not exist, therefore physicians must remain sceptical towards observational studies evaluating Procalcitonin. Interpretation of Procalcitonin levels must always include the clinical setting and knowledge of assay characteristics, particularly the setting of specific cut-off ranges and functional assay sensitivities. Highly sensitive Procalcitonin measurements, embedded in a clearly defined setting and prospectively validated with clinical algorithms were repeatedly effective in markedly reducing the (over)-utilisation of antimicrobial therapy. Today, this concept has been proven for lower respiratory tract infections and in pilot studies for meningitis and critically ill patients with sepsis. The higher the absolute risk for adverse outcome of a patient, the more cautious physicians must remain and empirical antibiotic therapies must be considered despite initial low Procalcitonin levels at the initial presentation. In these patients a Procalcitonin-guided shortening of antibiotic courses seems appropriate. The prognostic utility of initial Procalcitonin measurement in respiratory tract infections is suboptimal. Other biomarkers including cortisol, human growth hormone and prohormones from adrenomedullin and vasopressin ("copeptin") have a superior predictive potential to estimate the risk for short and long term mortality and other adverse outcomes in different diseases. An accurate prognostic assessment has the potential to optimise the management of patients and the allocation of our limited health care resources by lowering unnecessary hospitalisations and associated cost. Future intervention studies must prove if these biomarkers indeed improve clinical decision making and thus the overall medical management of patients.
-
antibiotic treatment of exacerbations of copd a randomized controlled trial comparing Procalcitonin guidance with standard therapy
Chest, 2007Co-Authors: Daiana Stolz, Mirjam Christcrain, Roland Bingisser, Peter Huber, Beat Muller, Jorg D Leuppi, David Miedinger, Christian Muller, Michael TammAbstract:Background: Therapy with antibiotics influences recovery only in selected cases of COPD exacerbations. We evaluated the efficacy and safety of Procalcitonin guidance compared to standard therapy with antibiotic prescriptions in patients experiencing exacerbations of COPD. Methods: A total of 208 consecutive patients requiring hospitalization for COPD exacerbation were randomized at the index exacerbation to Procalcitonin-guided or standard antibiotic therapy. Patients receiving Procalcitonin-guided therapy were treated with antibiotics according to serum Procalcitonin levels; standard-therapy patients received antibiotics according to the attending physician. The primary outcome was the antibiotic exposure at the index exacerbation and the subsequent antibiotic requirement for COPD exacerbation within 6 months. Secondary outcomes were clinical recovery, symptom scores, length of hospitalization, ICU stay, death, lung function, exacerbation rate, and time to next exacerbation. Results: At the index exacerbation, Procalcitonin guidance reduced antibiotic prescription (40% vs 72%, respectively; p < 0.0001) and antibiotic exposure (relative risk [RR], 0.56; 95% confidence interval [CI], 0.43 to 0.73; p < 0.0001) compared to standard therapy. Moreover, Procalcitonin guidance at the index exacerbation allowed a significant sustained reduction in total antibiotic exposure for up to 6 months (RR, 0.76; 95% CI, 0.64 to 0.92; p 0.004). Clinical outcome and improvement in FEV1 at 14 days and 6 months did not differ between groups. Within 6 months, the exacerbation rate (0.62 vs 0.64, respectively), the rehospitalization rate (0.21 vs 0.24, respectively), and mean ( SD) time to the next exacerbation (70.0 46.1 vs 70.4 51.9 days, respectively; p 0.523) were similar in both groups. Conclusions: Procalcitonin guidance for exacerbations of COPD offers a sustained advantage over standard therapy in reducing antibiotic use for up to 6 months with a number-needed-totreat of 3. (CHEST 2007; 131:9–19)
-
Procalcitonin guidance of antibiotic therapy in community acquired pneumonia a randomized trial
American Journal of Respiratory and Critical Care Medicine, 2006Co-Authors: Mirjam Christcrain, Roland Bingisser, Peter Huber, Michael Tamm, Daiana Stolz, David Miedinger, Christian Muller, Werner Zimmerli, Stephan Juergen Harbarth, Beat MullerAbstract:Rationale: In patients with community-acquired pneumonia, guidelines recommend antibiotic treatment for 7 to 21 d. Procalcitonin is elevated in bacterial infections, and its dynamics have prognostic implications.Objective: To assess Procalcitonin guidance for the initiation and duration of antibiotic therapy in community-acquired pneumonia.Methods: In a randomized intervention trial, 302 consecutive patients with suspected community-acquired pneumonia were included. Data were assessed at baseline, after 4, 6, and 8 d, and after 6 wk.The control group (n = 151) received antibiotics according to usual practice. In the Procalcitonin group (n = 151), antibiotic treatment was based on serum Procalcitonin concentrations as follows: strongly discouraged, less than 0.1 μg/L; discouraged, less than 0.25 μg/L; encouraged, greater than 0.25 μg/L; strongly encouraged, greater than 0.5 μg/L. The primary endpoint was antibiotic use; secondary endpoints were measures of clinical, laboratory, and radiographic outcome.Res...
-
effect of Procalcitonin guided treatment on antibiotic use and outcome in lower respiratory tract infections cluster randomised single blinded intervention trial
The Lancet, 2004Co-Authors: Mirjam Christcrain, Daiana Jaccardstolz, Roland Bingisser, Mikael Gencay, Peter Huber, Michael Tamm, Beat MullerAbstract:Summary Background Lower respiratory tract infections are often treated with antibiotics without evidence of clinically relevant bacterial disease. Serum calcitonin precursor concentrations, including Procalcitonin, are raised in bacterial infections. We aimed to assess a Procalcitonin-based therapeutic strategy to reduce antibiotic use in lower respiratory tract infections with a new rapid and sensitive assay. Methods 243 patients admitted with suspected lower respiratory tract infections were randomly assigned standard care (standard group; n=119) or Procalcitonin-guided treatment (Procalcitonin group; n=124). On the basis of serum Procalcitonin concentrations, use of antibiotics was more or less discouraged ( Findings Final diagnoses were pneumonia (n=87; 36%), acute exacerbation of chronic obstructive pulmonary disease (60; 25%), acute bronchitis (59; 24%), asthma (13; 5%), and other respiratory affections (24; 10%). Serological evidence of viral infection was recorded in 141 of 175 tested patients (81%). Bacterial cultures were positive from sputum in 51 (21%) and from blood in 16 (7%). In the Procalcitonin group, the adjusted relative risk of antibiotic exposure was 0·49 (95% CI 0·44–0·55; p Interpretation Procalcitonin guidance substantially reduced antibiotic use in lower respiratory tract infections. Withholding antimicrobial treatment did not compromise outcome. In view of the current overuse of antimicrobial therapy in often self-limiting acute respiratory tract infections, treatment based on Procalcitonin measurement could have important clinical and financial implications. Published online Feb 10, 2004. http://image.thelancet.com/extras/04art1162web.pdf
Philipp Schuetz - One of the best experts on this subject based on the ideXlab platform.
-
Procalcitonin testing to guide antibiotic therapy in acute upper and lower respiratory tract infections
JAMA, 2018Co-Authors: Philipp Schuetz, Yannick Wirz, Beat MuellerAbstract:Clinical Question Is the use of Procalcitonin for guiding antibiotic decisions in patients with acute upper and lower respiratory tract infections associated with improved clinical outcomes compared with usual care? Bottom Line Among patients with varying types and severity of acute respiratory infection, using Procalcitonin to guide decisions about antibiotics is associated with lower rates of antibiotic exposure, antibiotic-related adverse effects, and mortality.
-
effect of Procalcitonin guided antibiotic treatment on mortality in acute respiratory infections a patient level meta analysis
Lancet Infectious Diseases, 2018Co-Authors: Philipp Schuetz, Mirjam Christcrain, Yannick Wirz, Michael Tamm, Daiana Stolz, Lila Bouadma, Charles Edouard Luyt, Michel Wolff, Ramon Sager, Jean ChastreAbstract:Summary Background In February, 2017, the US Food and Drug Administration approved the blood infection marker Procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety of Procalcitonin-guided treatment in patients with acute respiratory infections from different clinical settings. Methods Based on a prespecified Cochrane protocol, we did a systematic literature search on the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, and pooled individual patient data from trials in which patients with respiratory infections were randomly assigned to receive antibiotics based on Procalcitonin concentrations (Procalcitonin-guided group) or control. The coprimary endpoints were 30-day mortality and setting-specific treatment failure. Secondary endpoints were antibiotic use, length of stay, and antibiotic side-effects. Findings We identified 990 records from the literature search, of which 71 articles were assessed for eligibility after exclusion of 919 records. We collected data on 6708 patients from 26 eligible trials in 12 countries. Mortality at 30 days was significantly lower in Procalcitonin-guided patients than in control patients (286 [9%] deaths in 3336 Procalcitonin-guided patients vs 336 [10%] in 3372 controls; adjusted odds ratio [OR] 0·83 [95% CI 0·70 to 0·99], p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (p interactions >0·05), although mortality was very low in primary care and in patients with acute bronchitis. Procalcitonin guidance was also associated with a 2·4-day reduction in antibiotic exposure (5·7 vs 8·1 days [95% CI −2·71 to −2·15], p vs 22%, adjusted OR 0·68 [95% CI 0·57 to 0·82], p Interpretation Use of Procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of Procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance. Funding National Institute for Health Research.
-
clinical outcomes associated with Procalcitonin algorithms to guide antibiotic therapy in respiratory tract infections
JAMA, 2013Co-Authors: Philipp Schuetz, Matthias Briel, Beat MuellerAbstract:Clinical Question In patients with respiratory tract infection, is measurement of Procalcitonin to guide antibiotic prescriptions associated with reduced antibiotic exposure without increases in all-cause mortality or treatment failure? Bottom Line The measurement of Procalcitonin to guide initiation and duration of antibiotic treatment in patients with respiratory tract infections of varying severity is associated with lower antibiotic exposure without increasing all-cause mortality or treatment failure.
-
Procalcitonin algorithms for antibiotic therapy decisions a systematic review of randomized controlled trials and recommendations for clinical algorithms
JAMA Internal Medicine, 2011Co-Authors: Philipp Schuetz, Victor Chiappa, Matthias Briel, Jeffrey L GreenwaldAbstract:Previous randomized controlled trials suggest that using clinical algorithms based on Procalcitonin levels, a marker of bacterial infections, results in reduced antibiotic use without a deleterious effect on clinical outcomes. However, algorithms differed among trials and were embedded primarily within the European health care setting. Herein, we summarize the design, efficacy, and safety of previous randomized controlled trials and propose adapted algorithms for US settings. We performed a systematic search and included all 14 randomized controlled trials (N = 4467 patients) that investigated Procalcitonin algorithms for antibiotic treatment decisions in adult patients with respiratory tract infections and sepsis from primary care, emergency department (ED), and intensive care unit settings. We found no significant difference in mortality between Procalcitonin-treated and control patients overall (odds ratio, 0.91; 95% confidence interval, 0.73-1.14) or in primary care (0.13; 0-6.64), ED (0.95; 0.67-1.36), and intensive care unit (0.89; 0.66-1.20) settings individually. A consistent reduction was observed in antibiotic prescription and/or duration of therapy, mainly owing to lower prescribing rates in low-acuity primary care and ED patients, and shorter duration of therapy in moderate- and high-acuity ED and intensive care unit patients. Measurement of Procalcitonin levels for antibiotic decisions in patients with respiratory tract infections and sepsis appears to reduce antibiotic exposure without worsening the mortality rate. We propose specific Procalcitonin algorithms for low-, moderate-, and high-acuity patients as a basis for future trials aiming at reducing antibiotic overconsumption.
-
Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections hope for hype
Swiss Medical Weekly, 2009Co-Authors: Philipp Schuetz, Mirjam Christcrain, Beat MullerAbstract:This review aims to provide physicians with an overview of the potential of Procalcitonin to guide antibiotic therapy in respiratory tract infections and in sepsis. Knowledge of the strengths and weaknesses of Procalcitonin are prerequisites for a rational and safe use in clinical routine. In most infections a true gold standard for diagnosis does not exist, therefore physicians must remain sceptical towards observational studies evaluating Procalcitonin. Interpretation of Procalcitonin levels must always include the clinical setting and knowledge of assay characteristics, particularly the setting of specific cut-off ranges and functional assay sensitivities. Highly sensitive Procalcitonin measurements, embedded in a clearly defined setting and prospectively validated with clinical algorithms were repeatedly effective in markedly reducing the (over)-utilisation of antimicrobial therapy. Today, this concept has been proven for lower respiratory tract infections and in pilot studies for meningitis and critically ill patients with sepsis. The higher the absolute risk for adverse outcome of a patient, the more cautious physicians must remain and empirical antibiotic therapies must be considered despite initial low Procalcitonin levels at the initial presentation. In these patients a Procalcitonin-guided shortening of antibiotic courses seems appropriate. The prognostic utility of initial Procalcitonin measurement in respiratory tract infections is suboptimal. Other biomarkers including cortisol, human growth hormone and prohormones from adrenomedullin and vasopressin ("copeptin") have a superior predictive potential to estimate the risk for short and long term mortality and other adverse outcomes in different diseases. An accurate prognostic assessment has the potential to optimise the management of patients and the allocation of our limited health care resources by lowering unnecessary hospitalisations and associated cost. Future intervention studies must prove if these biomarkers indeed improve clinical decision making and thus the overall medical management of patients.
Mirjam Christcrain - One of the best experts on this subject based on the ideXlab platform.
-
effect of Procalcitonin guided antibiotic treatment on mortality in acute respiratory infections a patient level meta analysis
Lancet Infectious Diseases, 2018Co-Authors: Philipp Schuetz, Mirjam Christcrain, Yannick Wirz, Michael Tamm, Daiana Stolz, Lila Bouadma, Charles Edouard Luyt, Michel Wolff, Ramon Sager, Jean ChastreAbstract:Summary Background In February, 2017, the US Food and Drug Administration approved the blood infection marker Procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety of Procalcitonin-guided treatment in patients with acute respiratory infections from different clinical settings. Methods Based on a prespecified Cochrane protocol, we did a systematic literature search on the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, and pooled individual patient data from trials in which patients with respiratory infections were randomly assigned to receive antibiotics based on Procalcitonin concentrations (Procalcitonin-guided group) or control. The coprimary endpoints were 30-day mortality and setting-specific treatment failure. Secondary endpoints were antibiotic use, length of stay, and antibiotic side-effects. Findings We identified 990 records from the literature search, of which 71 articles were assessed for eligibility after exclusion of 919 records. We collected data on 6708 patients from 26 eligible trials in 12 countries. Mortality at 30 days was significantly lower in Procalcitonin-guided patients than in control patients (286 [9%] deaths in 3336 Procalcitonin-guided patients vs 336 [10%] in 3372 controls; adjusted odds ratio [OR] 0·83 [95% CI 0·70 to 0·99], p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (p interactions >0·05), although mortality was very low in primary care and in patients with acute bronchitis. Procalcitonin guidance was also associated with a 2·4-day reduction in antibiotic exposure (5·7 vs 8·1 days [95% CI −2·71 to −2·15], p vs 22%, adjusted OR 0·68 [95% CI 0·57 to 0·82], p Interpretation Use of Procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of Procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance. Funding National Institute for Health Research.
-
Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections hope for hype
Swiss Medical Weekly, 2009Co-Authors: Philipp Schuetz, Mirjam Christcrain, Beat MullerAbstract:This review aims to provide physicians with an overview of the potential of Procalcitonin to guide antibiotic therapy in respiratory tract infections and in sepsis. Knowledge of the strengths and weaknesses of Procalcitonin are prerequisites for a rational and safe use in clinical routine. In most infections a true gold standard for diagnosis does not exist, therefore physicians must remain sceptical towards observational studies evaluating Procalcitonin. Interpretation of Procalcitonin levels must always include the clinical setting and knowledge of assay characteristics, particularly the setting of specific cut-off ranges and functional assay sensitivities. Highly sensitive Procalcitonin measurements, embedded in a clearly defined setting and prospectively validated with clinical algorithms were repeatedly effective in markedly reducing the (over)-utilisation of antimicrobial therapy. Today, this concept has been proven for lower respiratory tract infections and in pilot studies for meningitis and critically ill patients with sepsis. The higher the absolute risk for adverse outcome of a patient, the more cautious physicians must remain and empirical antibiotic therapies must be considered despite initial low Procalcitonin levels at the initial presentation. In these patients a Procalcitonin-guided shortening of antibiotic courses seems appropriate. The prognostic utility of initial Procalcitonin measurement in respiratory tract infections is suboptimal. Other biomarkers including cortisol, human growth hormone and prohormones from adrenomedullin and vasopressin ("copeptin") have a superior predictive potential to estimate the risk for short and long term mortality and other adverse outcomes in different diseases. An accurate prognostic assessment has the potential to optimise the management of patients and the allocation of our limited health care resources by lowering unnecessary hospitalisations and associated cost. Future intervention studies must prove if these biomarkers indeed improve clinical decision making and thus the overall medical management of patients.
-
antibiotic treatment of exacerbations of copd a randomized controlled trial comparing Procalcitonin guidance with standard therapy
Chest, 2007Co-Authors: Daiana Stolz, Mirjam Christcrain, Roland Bingisser, Peter Huber, Beat Muller, Jorg D Leuppi, David Miedinger, Christian Muller, Michael TammAbstract:Background: Therapy with antibiotics influences recovery only in selected cases of COPD exacerbations. We evaluated the efficacy and safety of Procalcitonin guidance compared to standard therapy with antibiotic prescriptions in patients experiencing exacerbations of COPD. Methods: A total of 208 consecutive patients requiring hospitalization for COPD exacerbation were randomized at the index exacerbation to Procalcitonin-guided or standard antibiotic therapy. Patients receiving Procalcitonin-guided therapy were treated with antibiotics according to serum Procalcitonin levels; standard-therapy patients received antibiotics according to the attending physician. The primary outcome was the antibiotic exposure at the index exacerbation and the subsequent antibiotic requirement for COPD exacerbation within 6 months. Secondary outcomes were clinical recovery, symptom scores, length of hospitalization, ICU stay, death, lung function, exacerbation rate, and time to next exacerbation. Results: At the index exacerbation, Procalcitonin guidance reduced antibiotic prescription (40% vs 72%, respectively; p < 0.0001) and antibiotic exposure (relative risk [RR], 0.56; 95% confidence interval [CI], 0.43 to 0.73; p < 0.0001) compared to standard therapy. Moreover, Procalcitonin guidance at the index exacerbation allowed a significant sustained reduction in total antibiotic exposure for up to 6 months (RR, 0.76; 95% CI, 0.64 to 0.92; p 0.004). Clinical outcome and improvement in FEV1 at 14 days and 6 months did not differ between groups. Within 6 months, the exacerbation rate (0.62 vs 0.64, respectively), the rehospitalization rate (0.21 vs 0.24, respectively), and mean ( SD) time to the next exacerbation (70.0 46.1 vs 70.4 51.9 days, respectively; p 0.523) were similar in both groups. Conclusions: Procalcitonin guidance for exacerbations of COPD offers a sustained advantage over standard therapy in reducing antibiotic use for up to 6 months with a number-needed-totreat of 3. (CHEST 2007; 131:9–19)
-
Procalcitonin guidance of antibiotic therapy in community acquired pneumonia a randomized trial
American Journal of Respiratory and Critical Care Medicine, 2006Co-Authors: Mirjam Christcrain, Roland Bingisser, Peter Huber, Michael Tamm, Daiana Stolz, David Miedinger, Christian Muller, Werner Zimmerli, Stephan Juergen Harbarth, Beat MullerAbstract:Rationale: In patients with community-acquired pneumonia, guidelines recommend antibiotic treatment for 7 to 21 d. Procalcitonin is elevated in bacterial infections, and its dynamics have prognostic implications.Objective: To assess Procalcitonin guidance for the initiation and duration of antibiotic therapy in community-acquired pneumonia.Methods: In a randomized intervention trial, 302 consecutive patients with suspected community-acquired pneumonia were included. Data were assessed at baseline, after 4, 6, and 8 d, and after 6 wk.The control group (n = 151) received antibiotics according to usual practice. In the Procalcitonin group (n = 151), antibiotic treatment was based on serum Procalcitonin concentrations as follows: strongly discouraged, less than 0.1 μg/L; discouraged, less than 0.25 μg/L; encouraged, greater than 0.25 μg/L; strongly encouraged, greater than 0.5 μg/L. The primary endpoint was antibiotic use; secondary endpoints were measures of clinical, laboratory, and radiographic outcome.Res...
-
effect of Procalcitonin guided treatment on antibiotic use and outcome in lower respiratory tract infections cluster randomised single blinded intervention trial
The Lancet, 2004Co-Authors: Mirjam Christcrain, Daiana Jaccardstolz, Roland Bingisser, Mikael Gencay, Peter Huber, Michael Tamm, Beat MullerAbstract:Summary Background Lower respiratory tract infections are often treated with antibiotics without evidence of clinically relevant bacterial disease. Serum calcitonin precursor concentrations, including Procalcitonin, are raised in bacterial infections. We aimed to assess a Procalcitonin-based therapeutic strategy to reduce antibiotic use in lower respiratory tract infections with a new rapid and sensitive assay. Methods 243 patients admitted with suspected lower respiratory tract infections were randomly assigned standard care (standard group; n=119) or Procalcitonin-guided treatment (Procalcitonin group; n=124). On the basis of serum Procalcitonin concentrations, use of antibiotics was more or less discouraged ( Findings Final diagnoses were pneumonia (n=87; 36%), acute exacerbation of chronic obstructive pulmonary disease (60; 25%), acute bronchitis (59; 24%), asthma (13; 5%), and other respiratory affections (24; 10%). Serological evidence of viral infection was recorded in 141 of 175 tested patients (81%). Bacterial cultures were positive from sputum in 51 (21%) and from blood in 16 (7%). In the Procalcitonin group, the adjusted relative risk of antibiotic exposure was 0·49 (95% CI 0·44–0·55; p Interpretation Procalcitonin guidance substantially reduced antibiotic use in lower respiratory tract infections. Withholding antimicrobial treatment did not compromise outcome. In view of the current overuse of antimicrobial therapy in often self-limiting acute respiratory tract infections, treatment based on Procalcitonin measurement could have important clinical and financial implications. Published online Feb 10, 2004. http://image.thelancet.com/extras/04art1162web.pdf
Daiana Stolz - One of the best experts on this subject based on the ideXlab platform.
-
effect of Procalcitonin guided antibiotic treatment on mortality in acute respiratory infections a patient level meta analysis
Lancet Infectious Diseases, 2018Co-Authors: Philipp Schuetz, Mirjam Christcrain, Yannick Wirz, Michael Tamm, Daiana Stolz, Lila Bouadma, Charles Edouard Luyt, Michel Wolff, Ramon Sager, Jean ChastreAbstract:Summary Background In February, 2017, the US Food and Drug Administration approved the blood infection marker Procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety of Procalcitonin-guided treatment in patients with acute respiratory infections from different clinical settings. Methods Based on a prespecified Cochrane protocol, we did a systematic literature search on the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, and pooled individual patient data from trials in which patients with respiratory infections were randomly assigned to receive antibiotics based on Procalcitonin concentrations (Procalcitonin-guided group) or control. The coprimary endpoints were 30-day mortality and setting-specific treatment failure. Secondary endpoints were antibiotic use, length of stay, and antibiotic side-effects. Findings We identified 990 records from the literature search, of which 71 articles were assessed for eligibility after exclusion of 919 records. We collected data on 6708 patients from 26 eligible trials in 12 countries. Mortality at 30 days was significantly lower in Procalcitonin-guided patients than in control patients (286 [9%] deaths in 3336 Procalcitonin-guided patients vs 336 [10%] in 3372 controls; adjusted odds ratio [OR] 0·83 [95% CI 0·70 to 0·99], p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (p interactions >0·05), although mortality was very low in primary care and in patients with acute bronchitis. Procalcitonin guidance was also associated with a 2·4-day reduction in antibiotic exposure (5·7 vs 8·1 days [95% CI −2·71 to −2·15], p vs 22%, adjusted OR 0·68 [95% CI 0·57 to 0·82], p Interpretation Use of Procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of Procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance. Funding National Institute for Health Research.
-
Procalcitonin for reduced antibiotic exposure in ventilator associated pneumonia a randomised study
European Respiratory Journal, 2009Co-Authors: Daiana Stolz, Nicholas A Smyrnios, Philippe Eggimann, Hans Pargger, Nehal Thakkar, Martin Siegemund, Stephan Marsch, Andrea Azzola, Janko Rakic, B MuellerAbstract:In patients with ventilator-associated pneumonia (VAP), guidelines recommend antibiotic therapy adjustment according to microbiology results after 72 h. Circulating Procalcitonin levels may provide evidence that facilitates the reduction of antibiotic therapy. In a multicentre, randomised, controlled trial, 101 patients with VAP were assigned to an antibiotic discontinuation strategy according to guidelines (control group) or to serum Procalcitonin concentrations (Procalcitonin group) with an antibiotic regimen selected by the treating physician. The primary end-point was antibiotic-free days alive assessed 28 days after VAP onset and analysed on an intent-to-treat basis. Procalcitonin determination significantly increased the number of antibiotic free-days alive 28 days after VAP onset (13 (2-21) days versus 9.5 (1.5-17) days). This translated into a reduction in the overall duration of antibiotic therapy of 27% in the Procalcitonin group (p = 0.038). After adjustment for age, microbiology and centre effect, the rate of antibiotic discontinuation on day 28 remained higher in the Procalcitonin group compared with patients treated according to guidelines (hazard rate 1.6, 95% CI 1.02-2.71). The number of mechanical ventilation-free days alive, intensive care unit-free days alive, length of hospital stay and mortality rate on day 28 for the two groups were similar. Serum Procalcitonin reduces antibiotic therapy exposure in patients with ventilator associated pneumonia.
-
antibiotic treatment of exacerbations of copd a randomized controlled trial comparing Procalcitonin guidance with standard therapy
Chest, 2007Co-Authors: Daiana Stolz, Mirjam Christcrain, Roland Bingisser, Peter Huber, Beat Muller, Jorg D Leuppi, David Miedinger, Christian Muller, Michael TammAbstract:Background: Therapy with antibiotics influences recovery only in selected cases of COPD exacerbations. We evaluated the efficacy and safety of Procalcitonin guidance compared to standard therapy with antibiotic prescriptions in patients experiencing exacerbations of COPD. Methods: A total of 208 consecutive patients requiring hospitalization for COPD exacerbation were randomized at the index exacerbation to Procalcitonin-guided or standard antibiotic therapy. Patients receiving Procalcitonin-guided therapy were treated with antibiotics according to serum Procalcitonin levels; standard-therapy patients received antibiotics according to the attending physician. The primary outcome was the antibiotic exposure at the index exacerbation and the subsequent antibiotic requirement for COPD exacerbation within 6 months. Secondary outcomes were clinical recovery, symptom scores, length of hospitalization, ICU stay, death, lung function, exacerbation rate, and time to next exacerbation. Results: At the index exacerbation, Procalcitonin guidance reduced antibiotic prescription (40% vs 72%, respectively; p < 0.0001) and antibiotic exposure (relative risk [RR], 0.56; 95% confidence interval [CI], 0.43 to 0.73; p < 0.0001) compared to standard therapy. Moreover, Procalcitonin guidance at the index exacerbation allowed a significant sustained reduction in total antibiotic exposure for up to 6 months (RR, 0.76; 95% CI, 0.64 to 0.92; p 0.004). Clinical outcome and improvement in FEV1 at 14 days and 6 months did not differ between groups. Within 6 months, the exacerbation rate (0.62 vs 0.64, respectively), the rehospitalization rate (0.21 vs 0.24, respectively), and mean ( SD) time to the next exacerbation (70.0 46.1 vs 70.4 51.9 days, respectively; p 0.523) were similar in both groups. Conclusions: Procalcitonin guidance for exacerbations of COPD offers a sustained advantage over standard therapy in reducing antibiotic use for up to 6 months with a number-needed-totreat of 3. (CHEST 2007; 131:9–19)
-
Procalcitonin guidance of antibiotic therapy in community acquired pneumonia a randomized trial
American Journal of Respiratory and Critical Care Medicine, 2006Co-Authors: Mirjam Christcrain, Roland Bingisser, Peter Huber, Michael Tamm, Daiana Stolz, David Miedinger, Christian Muller, Werner Zimmerli, Stephan Juergen Harbarth, Beat MullerAbstract:Rationale: In patients with community-acquired pneumonia, guidelines recommend antibiotic treatment for 7 to 21 d. Procalcitonin is elevated in bacterial infections, and its dynamics have prognostic implications.Objective: To assess Procalcitonin guidance for the initiation and duration of antibiotic therapy in community-acquired pneumonia.Methods: In a randomized intervention trial, 302 consecutive patients with suspected community-acquired pneumonia were included. Data were assessed at baseline, after 4, 6, and 8 d, and after 6 wk.The control group (n = 151) received antibiotics according to usual practice. In the Procalcitonin group (n = 151), antibiotic treatment was based on serum Procalcitonin concentrations as follows: strongly discouraged, less than 0.1 μg/L; discouraged, less than 0.25 μg/L; encouraged, greater than 0.25 μg/L; strongly encouraged, greater than 0.5 μg/L. The primary endpoint was antibiotic use; secondary endpoints were measures of clinical, laboratory, and radiographic outcome.Res...
Michael Tamm - One of the best experts on this subject based on the ideXlab platform.
-
effect of Procalcitonin guided antibiotic treatment on mortality in acute respiratory infections a patient level meta analysis
Lancet Infectious Diseases, 2018Co-Authors: Philipp Schuetz, Mirjam Christcrain, Yannick Wirz, Michael Tamm, Daiana Stolz, Lila Bouadma, Charles Edouard Luyt, Michel Wolff, Ramon Sager, Jean ChastreAbstract:Summary Background In February, 2017, the US Food and Drug Administration approved the blood infection marker Procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety of Procalcitonin-guided treatment in patients with acute respiratory infections from different clinical settings. Methods Based on a prespecified Cochrane protocol, we did a systematic literature search on the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, and pooled individual patient data from trials in which patients with respiratory infections were randomly assigned to receive antibiotics based on Procalcitonin concentrations (Procalcitonin-guided group) or control. The coprimary endpoints were 30-day mortality and setting-specific treatment failure. Secondary endpoints were antibiotic use, length of stay, and antibiotic side-effects. Findings We identified 990 records from the literature search, of which 71 articles were assessed for eligibility after exclusion of 919 records. We collected data on 6708 patients from 26 eligible trials in 12 countries. Mortality at 30 days was significantly lower in Procalcitonin-guided patients than in control patients (286 [9%] deaths in 3336 Procalcitonin-guided patients vs 336 [10%] in 3372 controls; adjusted odds ratio [OR] 0·83 [95% CI 0·70 to 0·99], p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (p interactions >0·05), although mortality was very low in primary care and in patients with acute bronchitis. Procalcitonin guidance was also associated with a 2·4-day reduction in antibiotic exposure (5·7 vs 8·1 days [95% CI −2·71 to −2·15], p vs 22%, adjusted OR 0·68 [95% CI 0·57 to 0·82], p Interpretation Use of Procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of Procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance. Funding National Institute for Health Research.
-
antibiotic treatment of exacerbations of copd a randomized controlled trial comparing Procalcitonin guidance with standard therapy
Chest, 2007Co-Authors: Daiana Stolz, Mirjam Christcrain, Roland Bingisser, Peter Huber, Beat Muller, Jorg D Leuppi, David Miedinger, Christian Muller, Michael TammAbstract:Background: Therapy with antibiotics influences recovery only in selected cases of COPD exacerbations. We evaluated the efficacy and safety of Procalcitonin guidance compared to standard therapy with antibiotic prescriptions in patients experiencing exacerbations of COPD. Methods: A total of 208 consecutive patients requiring hospitalization for COPD exacerbation were randomized at the index exacerbation to Procalcitonin-guided or standard antibiotic therapy. Patients receiving Procalcitonin-guided therapy were treated with antibiotics according to serum Procalcitonin levels; standard-therapy patients received antibiotics according to the attending physician. The primary outcome was the antibiotic exposure at the index exacerbation and the subsequent antibiotic requirement for COPD exacerbation within 6 months. Secondary outcomes were clinical recovery, symptom scores, length of hospitalization, ICU stay, death, lung function, exacerbation rate, and time to next exacerbation. Results: At the index exacerbation, Procalcitonin guidance reduced antibiotic prescription (40% vs 72%, respectively; p < 0.0001) and antibiotic exposure (relative risk [RR], 0.56; 95% confidence interval [CI], 0.43 to 0.73; p < 0.0001) compared to standard therapy. Moreover, Procalcitonin guidance at the index exacerbation allowed a significant sustained reduction in total antibiotic exposure for up to 6 months (RR, 0.76; 95% CI, 0.64 to 0.92; p 0.004). Clinical outcome and improvement in FEV1 at 14 days and 6 months did not differ between groups. Within 6 months, the exacerbation rate (0.62 vs 0.64, respectively), the rehospitalization rate (0.21 vs 0.24, respectively), and mean ( SD) time to the next exacerbation (70.0 46.1 vs 70.4 51.9 days, respectively; p 0.523) were similar in both groups. Conclusions: Procalcitonin guidance for exacerbations of COPD offers a sustained advantage over standard therapy in reducing antibiotic use for up to 6 months with a number-needed-totreat of 3. (CHEST 2007; 131:9–19)
-
Procalcitonin guidance of antibiotic therapy in community acquired pneumonia a randomized trial
American Journal of Respiratory and Critical Care Medicine, 2006Co-Authors: Mirjam Christcrain, Roland Bingisser, Peter Huber, Michael Tamm, Daiana Stolz, David Miedinger, Christian Muller, Werner Zimmerli, Stephan Juergen Harbarth, Beat MullerAbstract:Rationale: In patients with community-acquired pneumonia, guidelines recommend antibiotic treatment for 7 to 21 d. Procalcitonin is elevated in bacterial infections, and its dynamics have prognostic implications.Objective: To assess Procalcitonin guidance for the initiation and duration of antibiotic therapy in community-acquired pneumonia.Methods: In a randomized intervention trial, 302 consecutive patients with suspected community-acquired pneumonia were included. Data were assessed at baseline, after 4, 6, and 8 d, and after 6 wk.The control group (n = 151) received antibiotics according to usual practice. In the Procalcitonin group (n = 151), antibiotic treatment was based on serum Procalcitonin concentrations as follows: strongly discouraged, less than 0.1 μg/L; discouraged, less than 0.25 μg/L; encouraged, greater than 0.25 μg/L; strongly encouraged, greater than 0.5 μg/L. The primary endpoint was antibiotic use; secondary endpoints were measures of clinical, laboratory, and radiographic outcome.Res...
-
effect of Procalcitonin guided treatment on antibiotic use and outcome in lower respiratory tract infections cluster randomised single blinded intervention trial
The Lancet, 2004Co-Authors: Mirjam Christcrain, Daiana Jaccardstolz, Roland Bingisser, Mikael Gencay, Peter Huber, Michael Tamm, Beat MullerAbstract:Summary Background Lower respiratory tract infections are often treated with antibiotics without evidence of clinically relevant bacterial disease. Serum calcitonin precursor concentrations, including Procalcitonin, are raised in bacterial infections. We aimed to assess a Procalcitonin-based therapeutic strategy to reduce antibiotic use in lower respiratory tract infections with a new rapid and sensitive assay. Methods 243 patients admitted with suspected lower respiratory tract infections were randomly assigned standard care (standard group; n=119) or Procalcitonin-guided treatment (Procalcitonin group; n=124). On the basis of serum Procalcitonin concentrations, use of antibiotics was more or less discouraged ( Findings Final diagnoses were pneumonia (n=87; 36%), acute exacerbation of chronic obstructive pulmonary disease (60; 25%), acute bronchitis (59; 24%), asthma (13; 5%), and other respiratory affections (24; 10%). Serological evidence of viral infection was recorded in 141 of 175 tested patients (81%). Bacterial cultures were positive from sputum in 51 (21%) and from blood in 16 (7%). In the Procalcitonin group, the adjusted relative risk of antibiotic exposure was 0·49 (95% CI 0·44–0·55; p Interpretation Procalcitonin guidance substantially reduced antibiotic use in lower respiratory tract infections. Withholding antimicrobial treatment did not compromise outcome. In view of the current overuse of antimicrobial therapy in often self-limiting acute respiratory tract infections, treatment based on Procalcitonin measurement could have important clinical and financial implications. Published online Feb 10, 2004. http://image.thelancet.com/extras/04art1162web.pdf