Abstract
| Original language | English |
|---|---|
| Pages (from-to) | Online |
| Number of pages | 10 |
| Journal | Annals of Translational Medicine |
| Volume | 5 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - May 2017 |
Keywords
- Antibiotic
- Biomarkers
- C-reactive protein (CRP)
- Infection
- Procalcitonin (PCT)
- biological marker
- C reactive protein
- procalcitonin
- antibiotic therapy
- clinical decision making
- clinical practice
- control strategy
- cost effectiveness analysis
- critically ill patient
- data analysis
- health care cost
- human
- intensive care unit
- mortality
- outcome assessment
- primary medical care
- randomized controlled trial (topic)
- Review
- treatment duration
- treatment failure
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In: Annals of Translational Medicine, Vol. 5, No. 10, 05.2017, p. Online.
Research output: Contribution to journal › Review article › peer-review
TY - JOUR
T1 - Biomarker-guided antibiotic therapy-Strengths and limitations
AU - Nora, D.
AU - Salluh, J.
AU - Martin-Loeches, I.
AU - Póvoa, P.
N1 - Cited By :1 Export Date: 19 October 2017 Correspondence Address: Nora, D.; NOVA Medical School, New University of Lisbon, Rua Francisco Ferrer, 2-1D, Portugal; email: [email protected] Chemicals/CAS: C reactive protein, 9007-41-4; procalcitonin, 56645-65-9 References: Zilahi, G., Artigas, A., Loeches, I.M., What' s new in multidrug-resistant pathogens in the ICU? 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Sager, R., Kutz, A., Mueller, B., Procalcitonin-guided diagnosis and antibiotic stewardship revisited (2017) BMC Med, 15, p. 15; Schuetz, P., Albrich, W., Mueller, B., Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future (2011) BMC Med, 9, p. 107; Schuetz, P., Albrich, W., Christ-Crain, M., Procalcitonin for guidance of antibiotic therapy (2010) Expert Rev Anti Infect Ther, 8, pp. 575-587; Schuetz, P., Chiappa, V., Briel, M., Procalcitonin Algorithms for Antibiotic Therapy Decisions (2011) Arch Intern Med, 171, pp. 1322-1331; Schuetz, P., Müller, B., Stolz, D., Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections (2012) Cochrane Database Syst Rev, 9; Lin, C., Pang, Q., Meta-analysis and systematic review of procalcitonin-guided treatment in acute exacerbation of chronic obstructive pulmonary disease (2016) Clin Respir J, , [Epub ahead of print]; Andriolo, B.N., Andriolo, R., Salomão, R., Effectiveness and safety of procalcitonin evaluation for reducing mortality in adult patients with sepsis, severe sepsis and septic shock (2017) Cochrane Database Syst Rev, (1); Layios, N., Lambermont, B., Canivet, J.-L., Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients (2012) Crit Care Med, 40, pp. 2304-2309; Bouadma, L., Luyt, C., Tubach, F., Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial (2010) Lancet, 375, pp. 463-474; Jensen, J.U., Hein, L., Lundgren, B., Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial (2011) Crit Care Med, 39, pp. 2048-2058; Jensen, J.U., Heslet, L., Jensen, T.H., Procalcitonin increase in early identification of critically ill patients at high risk of mortality (2006) Crit Care Med, 34, pp. 2596-2602; de Jong, E., van Oers, J.A., Beishuizen, A., Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial (2016) Lancet Infect Dis, 16, pp. 819-827; Chastre, J., Wolff, M., Fagon, J.Y., Comparison of 8 vs 15 Days of Antibiotic Therapy for Ventilator-Associated Pneumonia in Adults-A Randomized Trial (2003) JAMA, 290, pp. 2588-2598; Pugh, R., Grant, C., Rpd, C., Short-course versus prolonged-course antibiotic therapy for hospital-acquired pneumonia in critically ill adults (Review) (2015) Cochrane Database Syst Rev, (8); Shehabi, Y., Sterba, M., Garrett, P.M., Procalcitonin Algorithm in Critically Ill Adults with Undifferentiated Infection or Suspected Sepsis A Randomized Controlled Trial (2014) Am J Respir Crit Care Med, 190, pp. 1102-1110; Annane, D., Maxime, V., Faller, J.P., Procalcitonin levels to guide antibiotic therapy in adults with non-microbiologically proven apparent severe sepsis: a randomised controlled trial (2013) BMJ Open, 3; Deliberato, R.O., Marra, A.R., Sanches, P.R., Clinical and economic impact of procalcitonin to shorten antimicrobial therapy in septic patients with proven bacterial infection in an intensive care setting (2013) Diagn Microbiol Infect Dis, 76, pp. 266-271; Hochreiter, M., Köhler, T., Schweiger, A.M., Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial (2009) Crit Care, 13; Stolz, D., Smyrnios, N., Eggimann, P., Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study (2009) Eur Respir J, 34, pp. 1364-1375; Schroeder, S., Hochreiter, M., Koehler, T., Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: Results of a prospective randomized study (2009) Langenbecks Arch Surg, 394, pp. 221-226; Nobre, V., Harbarth, S., Graf, J.-D., Use of Procalcitonin to Shorten Antibiotic Treatment Duration in Septic Patients (2008) Am J Respir Crit Care Med, 177, pp. 498-505; Svoboda, P., Kantorová, I., Scheer, P., Can procalcitonin help us in timing of re-intervention in septic patients after multiple trauma or major surgery? (2007) Hepatogastroenterology, 54, pp. 359-363; Rhodes, A., Evans, L.E., Alhazzani, W., Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016 (2017) Intensive Care Med, 43, pp. 304-377; Kalil, A.C., Metersky, M.L., Klompas, M., Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society (2016) Clin Infect Dis, 63, pp. e61-e111; Westwood, M., Ramaekers, B., Whiting, P., Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis (2015) Health Technol Assess, 19, pp. v-xxv and 1-236; Canovi, M., Lucchetti, J., Stravalaci, M., A new surface plasmon resonance-based immunoassay for rapid, reproducible and sensitive quantification of pentraxin-3 in human plasma (2014) Sensors, 14, pp. 10864-10875; Hansen, M.B., Rasmussen, L.S., Garred, P., Pentraxin-3 as a marker of disease severity and risk of death in patients with necrotizing soft tissue infections: a nationwide, prospective, observational study (2016) Crit Care, 20, p. 40; Póvoa, P., Salluh, J.I.F., Nobre, V., Martín-Loeches, I., Biomarker guided antibiotic therapy (2016) What's new? ICU Manag Pract, (1), pp. 24-28
PY - 2017/5
Y1 - 2017/5
N2 - Biomarkers as C-reactive protein (CRP) and procalcitonin (PCT) emerged as tools to help clinicians to diagnose infection and to properly initiate and define the duration of antibiotic therapy. Several randomized controlled trials, including adult critically ill patients, showed that PCT-guided antibiotic stewardship was repeatedly associated with a decrease in the duration of antibiotic therapy with no apparent harm. There are however some relevant limitations in these trials namely the low rate of compliance of PCT-guided algorithms, the high rate of exclusion (without including common clinical situations and pathogens) and the long duration of antibiotic therapy in control groups. Such limitations weakened the real impact of such algorithms in the clinical decision-making process and strengthened the concept that the initiation and the duration of antibiotic therapy cannot depend solely on a biomarker. Future efforts should address these limitations in order to better clarify the role of biomarkers on the complex and multifactorial issue of antibiotic management and to deeply understand its potential effect on mortality. © Annals of Translational Medicine. All rights reserved.
AB - Biomarkers as C-reactive protein (CRP) and procalcitonin (PCT) emerged as tools to help clinicians to diagnose infection and to properly initiate and define the duration of antibiotic therapy. Several randomized controlled trials, including adult critically ill patients, showed that PCT-guided antibiotic stewardship was repeatedly associated with a decrease in the duration of antibiotic therapy with no apparent harm. There are however some relevant limitations in these trials namely the low rate of compliance of PCT-guided algorithms, the high rate of exclusion (without including common clinical situations and pathogens) and the long duration of antibiotic therapy in control groups. Such limitations weakened the real impact of such algorithms in the clinical decision-making process and strengthened the concept that the initiation and the duration of antibiotic therapy cannot depend solely on a biomarker. Future efforts should address these limitations in order to better clarify the role of biomarkers on the complex and multifactorial issue of antibiotic management and to deeply understand its potential effect on mortality. © Annals of Translational Medicine. All rights reserved.
KW - Antibiotic
KW - Biomarkers
KW - C-reactive protein (CRP)
KW - Infection
KW - Procalcitonin (PCT)
KW - biological marker
KW - C reactive protein
KW - procalcitonin
KW - antibiotic therapy
KW - clinical decision making
KW - clinical practice
KW - control strategy
KW - cost effectiveness analysis
KW - critically ill patient
KW - data analysis
KW - health care cost
KW - human
KW - intensive care unit
KW - mortality
KW - outcome assessment
KW - primary medical care
KW - randomized controlled trial (topic)
KW - Review
KW - treatment duration
KW - treatment failure
U2 - 10.21037/atm.2017.04.04
DO - 10.21037/atm.2017.04.04
M3 - Review article
C2 - 28603723
SN - 2305-5839
VL - 5
SP - Online
JO - Annals of Translational Medicine
JF - Annals of Translational Medicine
IS - 10
ER -