Streamlining antibiotic therapy with procalcitonin protocols: Consensus and controversies

Expert Review of Respiratory Medicine

Volumn 7, Issue 2, 2013, Pages 145-157

  Haubitz, Sebastian ^a   Mueller, Beat ^a   Schuetz, Philipp ^a  

^a UNIVERSITY OF BASEL   (Switzerland)

Author keywords

antibiotic stewardship; intensive care unit; personalized medicine; pneumonia; procalcitonin; respiratory tract infection; sepsis

Indexed keywords

ANTIBIOTIC AGENT; BIOLOGICAL MARKER; C REACTIVE PROTEIN; GAMMA INTERFERON; INTERLEUKIN 1BETA; INTERLEUKIN 6; PROCALCITONIN; SODIUM SELENITE; TUMOR NECROSIS FACTOR ALPHA;

ALGORITHM; ANTIBIOTIC RESISTANCE; ANTIBIOTIC THERAPY; BRONCHITIS; CHRONIC OBSTRUCTIVE LUNG DISEASE; COMMUNITY ACQUIRED PNEUMONIA; CONSENSUS; COST EFFECTIVENESS ANALYSIS; CRITICALLY ILL PATIENT; DIAGNOSTIC KIT; DIAGNOSTIC VALUE; DISEASE SEVERITY; DOCTOR PATIENT RELATION; DRUG COST; DRUG DOSE ESCALATION; DRUG EXPOSURE; DRUG SAFETY; DRUG TREATMENT FAILURE; HEALTH CARE COST; HEALTH CARE QUALITY; HORMONE DETERMINATION; HUMAN; INFECTION; INTENSIVE CARE UNIT; NOSOCOMIAL; PNEUMONIA SEVERITY INDEX; PROGNOSIS; RESPIRATORY TRACT INFECTION; REVIEW; SUBACUTE ENDOCARDITIS; SYSTEMIC INFLAMMATORY RESPONSE SYNDROME; UNSPECIFIED SIDE EFFECT; VENTILATOR ASSOCIATED PNEUMONIA;

EID: 84875837993     PISSN: 17476348     EISSN: 17476356     Source Type: Journal    
DOI: 10.1586/ers.13.6     Document Type: Review

References (88)

1. Müller B, White JC, Nylen ES, Snider RH, Becker KL, Habener JF. Ubiquitous expression of the calcitonin-i gene in multiple tissues in response to sepsis. J. Clin. Endocrinol. Metab. 86(1), 396-404 (2001). (Pubitemid 32109825)
2. Gogos CA, Drosou E, Bassaris HP, Skoutelis A. Pro-versus anti-infammatory cytokine profle in patients with severe sepsis: a marker for prognosis and future therapeutic options. J. Infect. Dis. 181(1), 176-180 (2000). (Pubitemid 30049046)
3. Christ-Crain M, Muller B. Procalcitonin in bacterial infections - hype, hope, more or less? Swiss Med. Wkly 135(31-32), 451-460 (2005). (Pubitemid 41376648)
4. Christ-Crain M, Müller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur. Respir. J. 30(3), 556-573 (2007). (Pubitemid 351182082)
5. Linscheid P, Seboek D, Zulewski H, Keller U, Müller B. Autocrine/paracrine role of infammation-mediated calcitonin gene-related peptide and adrenomedullin expression in human adipose tissue. Endocrinology 146(6), 2699-2708 (2005). (Pubitemid 40695573)
6. Haeuptle J, Zaborsky R, Fiumefreddo R et al. Prognostic value of procalcitonin in Legionella pneumonia. Eur. J. Clin. Microbiol. Infect. Dis. 28(1), 55-60 (2009).
7. Jensen JU, Heslet L, Jensen TH, Espersen K, Steffensen P, Tvede M. Procalcitonin increase in early identifcation of critically ill patients at high risk of mortality. Crit. Care Med. 34(10), 2596-2602 (2006). (Pubitemid 44413058)
8. Müller B, Peri G, Doni A et al. High circulating levels of the IL-1 type II decoy receptor in critically ill patients with sepsis: association of high decoy receptor levels with glucocorticoid administration. J. Leukoc. Biol. 72(4), 643-649 (2002). (Pubitemid 36277834)
9. Harbarth S, Holeckova K, Froidevaux C et al.; Geneva Sepsis Network. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am. J. Respir. Crit. Care Med. 164(3), 396-402 (2001). (Pubitemid 32778205)
10. de Kruif MD, Lemaire LC, Giebelen IA et al. The infuence of corticosteroids on the release of novel biomarkers in human endotoxemia. Intensive Care Med. 34(3), 518-522 (2008). (Pubitemid 351623033)
11. Massaro KS, Costa SF, Leone C, Chamone DA. Procalcitonin (PCT) and C-reactive protein (CRP) as severe systemic infection markers in febrile neutropenic adults. BMC Infect. Dis. 7, 137 (2007).
12. Gibot S, Cravoisy A, Kolopp-Sarda MN et al. Time-course of sTREM (soluble triggering receptor expressed on myeloid cells)-1, procalcitonin, and C-reactive protein plasma concentrations during sepsis. Crit. Care Med. 33(4), 792-796 (2005).
13. Müller B, Gencay MM, Gibot S et al. Circulating levels of soluble triggering receptor expressed on myeloid cells (sTREM)-1 in community-acquired pneumonia. Crit. Care Med. 35(3), 990-991 (2007). (Pubitemid 46407853)
14. Smith RP, Lipworth BJ, Cree IA, Spiers EM, Winter JH. C-reactive protein. A clinical marker in community-acquired pneumonia. Chest 108(5), 1288-1291 (1995).
15. McCarthy PL, Tomasso L, Dolan TF Jr. Predicting fever response of children with pneumonia treated with antibiotics. Clin. Pediatr. (Phila.) 19(11), 753-760 (1980). (Pubitemid 11240889)
16. Müller B, Harbarth S, Stolz D et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect. Dis. 7, 10 (2007).
17. van der Meer V, Neven AK, van den Broek PJ, Assendelft WJ. Diagnostic value of C reactive protein in infections of the lower respiratory tract: systematic review. BMJ 331(7507), 26 (2005).
18. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin. Infect. Dis. 39(2), 206-217 (2004). (Pubitemid 38971491)
19. Gibot S, Cravoisy A, Levy B, Bene MC, Faure G, Bollaert PE. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N. Engl. J. Med. 350 (5), 451- 458 (2004). (Pubitemid 38133765)
20. Cals JW, Butler CC, Hopstaken RM, Hood K, Dinant GJ. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ 338, b1374 (2009).
21. Póvoa P, Salluh JI. Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review. Ann. Intensive Care 2(1), 32 (2012).
22. Nylen ES, Whang KT, Snider RH Jr, Steinwald PM, White JC, Becker KL. Mortality is increased by procalcitonin and decreased by an antiserum reactive to procalcitonin in experimental sepsis. Crit. Care Med. 26(6), 1001-1006 (1998). (Pubitemid 28272848)
23. Becker KL, Nylen ES, Snider RH, Müller B, White JC. Immunoneutralization of procalcitonin as therapy of sepsis. J. Endotoxin Res. 9(6), 367-374 (2003). (Pubitemid 38035600)
24. Wagner KE, Martinez JM, Vath SD et al. Early immunoneutralization of calcitonin precursors attenuates the adverse physiologic response to sepsis in pigs. Crit. Care Med. 30(10), 2313-2321 (2002). (Pubitemid 35191584)
25. Martinez JM, Wagner KE, Snider RH et al. Late immunoneutralization of procalci-tonin arrests the progression of lethal porcine sepsis. Surg. Infect. (Larchmt) 2(3), 193-202; discussion 202 (2001).
26. Steinbach G, Rau B, Debard AL et al. Multicenter evaluation of a new immuno-assay for procalcitonin measurement on the Kryptor System. Clin. Chem. Lab. Med. 42(4), 440-449 (2004). (Pubitemid 38585189)
27. Schuetz P, Christ-Crain M, Huber AR, Müller B. Long-term stability of procalci-tonin in frozen samples and comparison of Kryptor and VIDAS automated immunoas-says. Clin. Biochem. 43(3), 341-344 (2010).
28. Hubl W, Krassler J, Zingler C et al. Evaluation of a fully automated procalci-tonin chemiluminescence immunoassay. Clin. Lab. 49(7-8), 319-327 (2003). (Pubitemid 36975251)
29. de Wolf HK, Gunnewiek JK, Berk Y, van den Ouweland J, de Metz M. Comparison of a new procalcitonin assay from Roche with the established method on the brahms kryptor. Clin. Chem. 55(5), 1043 -1044 (2009).
30. Canale DD, Donabedian RK. Hypercalci-toninemia in acute pancreatitis. J. Clin. Endocrinol. Metab. 40(4), 738-741 (1975).
31. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341(8844), 515-518 (1993). (Pubitemid 23066085)
32. Pizzo PA. Evaluation of fever in the patient with cancer. Eur. J. Cancer Clin. Oncol. 25 (Suppl. 2), S9-16 (1989).
33. Müller B, Becker KL, Schächinger H et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit. Care Med. 28(4), 977-983 (2000). (Pubitemid 30262065)
34. Marshall JC. Sepsis: rethinking the approach to clinical research. J. Leukoc. Biol. 83(3), 471-482 (2008). (Pubitemid 351966853)
35. Bachmann LM, Jüni P, Reichenbach S, Ziswiler HR, Kessels AG, Vögelin E. Consequences of different diagnostic 'gold 32 standards' in test accuracy research: carpal tunnel syndrome as an example. Int. J. Epidemiol. 34(4), 953-955 (2005). (Pubitemid 41418849)
36. Simmonds MC, Higgins JP, Stewart LA, Tierney JF, Clarke MJ, Thompson SG. Meta-analysis of individual patient data from randomized trials: a review of methods used in practice. Clin. Trials 2(3), 209-217 (2005). (Pubitemid 40910470)
37. Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect. Dis. 7(3), 210 -217 (2007). (Pubitemid 46274517)
38. Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA. Procalcitonin test in the diagnosis of bacteremia: a meta-analysis. Ann. Emerg. Med. 50(1), 34-41 (2007). (Pubitemid 46907302)
39. Hunziker S, Hügle T, Schuchardt K et al. The value of serum procalcitonin level for differentiation of infectious from noninfec-tious causes of fever after orthopaedic surgery. J. Bone Joint Surg. Am. 92(1), 138-148 (2010).
40. Hügle T, Schuetz P, Mueller B et al. Serum procalcitonin for discrimination between septic and non-septic arthritis. Clin. Exp. Rheumatol. 26(3), 453-456 (2008). (Pubitemid 352003215)
41. Marc E, Menager C, Moulin F et al. [Procalcitonin and viral meningitis: reduction of unnecessary antibiotics by measurement during an outbreak]. Arch. Pediatr. 9(4), 358-364 (2002). (Pubitemid 34406924)
42. Schuetz P, Mueller B, Trampuz A. Serum procalcitonin for discrimination of blood contamination from bloodstream infection due to coagulase-negative staphylococci. Infection 35 (5), 352 -355 (2007). (Pubitemid 47502359)
43. Sakr Y, Sponholz C, Tuche F, Brunkhorst F, Reinhart K. The role of procalcitonin in febrile neutropenic patients: review of the literature. Infection 36(5), 396-407 (2008).
44. Mueller C, Christ-Crain M, Müller B. What cardiologists do need to know about procalcitonin. Clin. Lab. 51(1-2), 1-4 (2005). (Pubitemid 40260253)
45. Krüger S, Ewig S, Papassotiriou J et al.; CAPNETZ Study Group. Infammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP: results from the German competence network CAPNETZ. Respir. Res. 10, 65 (2009).
46. Schuetz P, Christ-Crain M, Wolbers M et al.; ProHOSP Study Group. Procalci-tonin guided antibiotic therapy and hospitalization in patients with lower respiratory tract infections: a prospective, multicenter, randomized controlled trial. BMC Health Serv. Res. 7, 102 (2007).
47. 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. 177(5), 498-505 (2008). (Pubitemid 351442188)
48. Bouadma L, Luyt CE, Tubach F et al.; PRORATA trial group. Use of procalci tonin to reduce patients' exposure to antibiotics in intensive care units (PRO RATA trial): a multicentre randomised controlled trial. Lancet 375 (9713), 463-474 (2010).
49. Hochreiter M, Köhler T, Schweiger AM et al. Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial. Crit. Care 13(3), R83 (2009).
50. Christ-Crain M, Jaccard-Stolz D, Bingisser R et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet 363(9409), 600-607 (2004). (Pubitemid 38264177)
51. Christ-Crain M, Stolz D, Bingisser R et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am. J. Respir. Crit Care Med. 174(1), 84-93 (2006). (Pubitemid 43955248)
52. Stolz D, Christ-Crain M, Bingisser R et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 131(1), 9-19 (2007). (Pubitemid 46122969)
53. Schuetz P, Christ-Crain M, Wolbers M et al. Effect of procalcitonin-based guidelines compared to standard guidelines on antibiotic use in lower respiratory tract infections: the randomized-controlled multicenter ProHOSP Trial. JAMA 302(10), 1059-1066 (2009).
54. Schuetz P, Briel M, Christ-Crain M et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis. Clin. Infect. Dis. 55(5), 651-662 (2012).
55. Schuetz P, Briel M, Mueller B. Clinical outcomes associated with procalcitonin algorithms to guide antibiotic therapy in respiratory tract infections. JAMA 309(7), 717-718 (2013).
56. Mandell LA, Wunderink RG, Anzueto A et al.; Infectious Diseases Society of America; American Thoracic Society Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin. Infect. Dis. 44(Suppl. 2), S27-S72 (2007). (Pubitemid 46290553)
57. Aujesky D, McCausland JB, Whittle J, Obrosky DS, Yealy DM, Fine MJ. Reasons why emergency department providers do not rely on the pneumonia severity index to determine the initial site of treatment for patients with pneumonia. Clin. Infect. Dis. 49(10), e100-e108 (2009).
58. Schuetz P, Batschwaroff M, Dusemund F et al. Effectiveness of a procalcitonin algorithm to guide antibiotic therapy in respiratory tract infections outside of study conditions: a post-study survey. Eur. J. Clin. Microbiol. Infect. Dis. 29(3), 269-277 (2010).
59. Albrich WC, Dusemund F, Bucher B et al.; ProREAL Study Team. Effectiveness and safety of procalcitonin-guided antibiotic therapy in lower respiratory tract infections in 'real life': an international, multicenter poststudy survey (ProREAL). Arch. Intern. Med. 172(9), 715-722 (2012).
60. Gonzales R, Steiner JF, Sande MA. Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians. JAMA 278(11), 901-904 (1997). (Pubitemid 27492241)
61. Gonzales R, Sande MA. Uncomplicated acute bronchitis. Ann. Intern. Med. 133(12), 981-991 (2000). (Pubitemid 32003514)
62. Gonzales R, Bartlett JG, Besser RE et al.; American Academy of Family Physicians; American College of Physicians - American Society of Internal Medicine; Centers for Disease Control; Infectious Diseases Society of America. Principles of appropriate antibiotic use for treatment of uncomplicated acute bronchitis: background. Ann. Intern. Med. 134(6), 521-529 (2001).
63. Briel M, Christ-Crain M, Young J et al. Procalcitonin-guided antibiotic use versus a standard approach for acute respiratory tract infections in primary care: study protocol for a randomised controlled trial and baseline characteristics of participating general practitioners [IS-RCTN73182671]. BMC Fam. Pract. 6, 34 (2005).
64. Briel M, Schuetz P, Mueller B et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch. Intern. Med. 168(18), 2000-2007; discussion 2007 (2008).
65. Burkhardt O, Ewig S, Haagen U et al. Procalcitonin guidance and reduction of antibiotic use in acute respiratory tract infection. Eur. Respir. J. 36(3), 601-607 (2010).
66. Amin DN, Pruitt JC, Schuetz P. Infuence of major cardiopulmonary surgery on serum levels of procalcitonin and other infammatory markers. Anaesth. Intensive Care 40(5), 760-766 (2012).
67. Maravic-Stojkovic V, Lausevic-Vuk L, Jovic M, Rankovic A, Borzanovic M, Marinko-vic J. Procalcitonin-based therapeutic strategy to reduce antibiotic use in patients after cardiac surgery: a randomized controlled trial. Srp. Arh. Celok. Lek. 139(11-12), 736-742 (2011).
68. Albrich WC, Monnet DL, Harbarth S. Antibiotic selection pressure and resistance in Streptococcus pneumoniae and Streptococcus pyogenes. Emerging Infect. Dis. 10(3), 514-517 (2004). (Pubitemid 38314485)
69. Willemsen I, Bogaers-Hofman D, Winters M, Kluytmans J. Correlation between antibiotic use and resistance in a hospital: temporary and ward-specifc observations. Infection 37(5), 432-437 (2009).
70. Harbarth S, Albrich W, Goldmann DA, Huebner J. Control of multiply resistant cocci: do international comparisons help? Lancet Infect. Dis. 1(4), 251-261 (2001). (Pubitemid 33586057)
71. Nasrin D, Collignon PJ, Roberts L, Wilson EJ, Pilotto LS, Douglas RM. Effect of beta lactam antibiotic use in children on pneumococcal resistance to penicillin: prospective cohort study. BMJ 324(7328), 28-30 (2002). (Pubitemid 34048851)
72. Dagan R, Barkai G, Givon-Lavi N et al. Seasonality of antibiotic-resistant Streptococcus pneumoniae that causes acute otitis media: a clue for an antibiotic-restric tion policy? J. Infect. Dis. 197(8), 1094-1102 (2008). (Pubitemid 351590044)
73. Seppälä H, Klaukka T, Vuopio-Varkila J et al. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance. N. Engl. J. Med. 337(7), 441-446 (1997). (Pubitemid 27333044)
74. Rice LB. The Maxwell Finland Lecture: for the duration-rational antibiotic administration in an era of antimicrobial resistance and Clostridium diffcile. Clin. Infect. Dis. 46(4), 491-496 (2008). (Pubitemid 351263484)
75. Reed SD, Laxminarayan R, Black DJ, Sullivan SD. Economic issues and antibiotic resistance in the community. Ann. Pharmacother. 36(1), 148-154 (2002). (Pubitemid 34052956)
76. Müller F, Christ-Crain M, Bregenzer T et al.; ProHOSP Study Group. Procalci-tonin levels predict bacteremia in patients with community-acquired pneumonia: a prospective cohort trial. Chest 138(1), 121-129 (2010).
77. Dellinger R P, Levy MM, Rhodes A et al.; Surviving Sepsis Campaign Guidelines Committee; Pediatric Subgroup. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012. Crit. Care Med. 41(2), 580-637 (2013).
78. Layios N, Lambermont B, Canivet JL et al. Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients. Crit. Care Med. 40(8), 2304-2309 (2012).
79. Jensen JU, Hein L, Lundgren B et al.; Proc-alcitonin And Survival Study (PASS) Group. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Crit. Care Med. 39(9), 2048-2058 (2011).
80. Schuetz P, Mueller B. To escalate or to de-escalate - that is the question. Crit. Care Med. 39(11), 2590; author reply 2591 (2011).
81. Manzano S, Bailey B, Girodias JB, Galetto-Lacour A, Cousineau J, Delvin E. Impact of procalcitonin on the manage ment of children aged 1 to 36 months presenting with fever without source: a randomized controlled trial. Am. J. Emerg. Med. 28(6), 647-653 (2010).
82. van Nieuwkoop C, Bonten TN, van't Wout JW et al. Procalcitonin refects bacteremia and bacterial load in urosepsis syndrome: a prospective observational study. Crit. Care 14(6), R206 (2010).
83. Kim DY, Lee YS, Ahn S, Chun YH, Lim KS. The usefulness of procalcitonin and C-reactive protein as early diagnostic markers of bacteremia in cancer patients with febrile neutropenia. Cancer Res. Treat. 43(3), 176-180 (2011).
84. Davies JE. Origins, acquisition and dissemination of antibiotic resistance determinants. In: Antibiotic Resistance: Origins, Evolution, Selection, and Spread. John Wiley & Sons, NY, USA 15-35 (1997).
85. Hayashi Y, Paterson DL. Strategies for reduction in duration of antibiotic use in hospitalized patients. Clin. Infect. Dis. 52(10), 1232-1240 (2011).
86. Dellit TH, Owens RC, McGowan JE Jr et al.; Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin. Infect. Dis. 44(2), 159-177 (2007). (Pubitemid 46084814)
87. Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret GY. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit. Care Med. 34(7), 1996-2003 (2006). (Pubitemid 43982479)
88. Schuetz P, Albrich W, Christ-Crain M, Chastre J, Mueller B. Procalcitonin for guidance of antibiotic therapy. Expert Rev. Anti Infect. Ther. 8(5), 575-587 (2010).