When once is not enough – further evidence of procalcitonin-guided antibiotic stewardship
Tóm tắt
Every day, critical care physicians around the world face the same challenge of the optimal timing of antimicrobial administration: when to start and when to stop antibiotics. Duration of antibiotic therapy for sepsis is mostly based on expert opinion, but its reduction is arguably the most promising approach to decrease emergence and selection of antibiotic resistance. The study by Hochreiter and colleagues presents another piece of evidence suggesting that procalcitonin may indeed be a valuable diagnostic parameter to guide antibiotic treatment duration, despite the ongoing controversy about the diagnostic accuracy of pro-calcitonin.
Tài liệu tham khảo
Hochreiter M, Kohler T, Schweiger AM, Keck FS, Bein B, von Spiegel T, Schroeder S: Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial. Crit Care 2009, 13: R83. 10.1186/cc7903
Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG: Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007,44(Suppl 2):S27-S72. 10.1086/511159
Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, Clementi E, Gonzalez J, Jusserand D, Asfar P, Perrin D, Fieux F, Aubas S, for the PneumA Trial Group: Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003, 290: 2588-2598. 10.1001/jama.290.19.2588
Dimopoulos G, Matthaiou DK, Karageorgopoulos DE, Grammatikos AP, Athanassa Z, Falagas ME: Short- versus long-course antibacterial therapy for community-acquired pneumonia: a meta-analysis. Drugs 2008, 68: 1841-1854. 10.2165/00003495-200868130-00004
Briel M, Schuetz P, Mueller B, Young J, Schild U, Nusbaumer C, Periat P, Bucher HC, Christ-Crain M: Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med 2008, 168: 2000-2007. discussion 2007–2008. 10.1001/archinte.168.18.2000
Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, Muller B: Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet 2004, 363: 600-607. 10.1016/S0140-6736(04)15591-8
Christ-Crain M, Stolz D, Bingisser R, Muller C, Miedinger D, Huber PR, Zimmerli W, Harbarth S, Tamm M, Muller B: Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006, 174: 84-93. 10.1164/rccm.200512-1922OC
Stolz D, Christ-Crain M, Bingisser R, Leuppi J, Miedinger D, Muller C, Huber P, Muller B, Tamm M: Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 2007, 131: 9-19. 10.1378/chest.06-1500
Procalcitonin Reduces Antibiotic Treatments in Acute-ill Patients (PRORATA)[http://clinicaltrials.gov/ct2/show/NCT00472667]
Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J: Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 2008, 177: 498-505. 10.1164/rccm.200708-1238OC
Schuetz P, Christ-Crain M, Wolbers M, Schild U, Thomann R, Falconnier C, Widmer I, Neidert S, Blum CA, Schonenberger R, Henzen C, Bregenzer T, Hoess C, Krause M, Bucher HC, Zimmerli W, Müller B, for the ProHOSP study group: Procalcitonin guided antibiotic therapy and hospitalization in patients with lower respiratory tract infections: a prospective, multicenter, randomized controlled trial. BMC Health Serv Res 2007, 7: 102. 10.1186/1472-6963-7-102
Hochreiter M, Kohler T, Schweiger AM, Keck FS, Bein B, von Spiegel T, Schroder S: Antibiotic treatment of surgical intensive care patients: procalcitonin to guide duration of therapy. Anaesthesist 2008, 57: 571-577. 10.1007/s00101-008-1379-x
Schroeder S, Hochreiter M, Koehler T, Schweiger AM, Bein B, Keck FS, von Spiegel T: Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Langenbecks Arch Surg 2009, 394: 221-226. 10.1007/s00423-008-0432-1
Nylen E, Muller B, Becker KL, Snider R: The future diagnostic role of procalcitonin levels: the need for improved sensitivity. Clin Infect Dis 2003, 36: 823-824. author reply 826–827. 10.1086/368088
Christ-Crain M, Muller B: Procalcitonin in bacterial infections-hype, hope, more or less? Swiss Med Wkly 2005, 135: 451-460.
Shehabi Y, Seppelt I: Pro/Con debate: is procalcitonin useful for guiding antibiotic decision making in critically ill patients? Crit Care 2008, 12: 211. 10.1186/cc6860