Yuri van der Does1, Pleunie P M Rood2, Juanita A Haagsma3, Peter Patka4, Eric C M van Gorp5, Maarten Limper6. 1. Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: y.vanderdoes@erasmusmc.nl. 2. Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: p.rood@erasmusmc.nl. 3. Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: j.haagsma@erasmusmc.nl. 4. Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: p.patka@erasmusmc.nl. 5. Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: e.vangorp@erasmusmc.nl. 6. Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: m.limper@erasmusmc.nl.
Abstract
BACKGROUND: Procalcitonin (PCT) is a new biomarker with a higher accuracy in the diagnosis of bacterial infections. Utilization of PCT may reduce the number of unnecessary antibiotics prescribed to patients and consequently may decrease the rise in antibiotic resistance. The aim of this systematic review is to determine if a PCT-guided algorithm can safely reduce the number of antibiotics prescribed to all patients with a suspected of infection in the emergency department (ED). METHODS: MEDLINE, EMBASE, Web of Science, COCHRANE central, PubMed publisher, and Google scholar were searched. Two reviewers performed the screening independently. The QUADAS 2 tool was used to assess quality. RESULTS: In total, 1621 articles were screened. Nine articles were included in the analysis. In the 6 studies on adult patients, only patients with respiratory tract infections were investigated. In these studies, a cutoff value of 0.25 μg/L was used, and PCT-guided therapy reduced the number of prescribed antibiotics significantly. Three studies were on pediatric patients, 2 on fever without source and 1 on respiratory complaints. Procalcitonin-guided therapy did not reduce antibiotic prescription in children. Procalcitonin-guided therapy did not result in an increase in adverse events in any of the studies. DISCUSSION: Procalcitonin-guided therapy in the ED is only studied in subpopulations, where it was effective and safe in adult patients with respiratory tract infections and not effective but safe nonetheless in specific pediatric populations. Nonadherence is a significant problem in prospective PCT-guided therapy studies. There is not enough evidence to use PCT-guided therapy in a general ED population.
BACKGROUND: Procalcitonin (PCT) is a new biomarker with a higher accuracy in the diagnosis of bacterial infections. Utilization of PCT may reduce the number of unnecessary antibiotics prescribed to patients and consequently may decrease the rise in antibiotic resistance. The aim of this systematic review is to determine if a PCT-guided algorithm can safely reduce the number of antibiotics prescribed to all patients with a suspected of infection in the emergency department (ED). METHODS: MEDLINE, EMBASE, Web of Science, COCHRANE central, PubMed publisher, and Google scholar were searched. Two reviewers performed the screening independently. The QUADAS 2 tool was used to assess quality. RESULTS: In total, 1621 articles were screened. Nine articles were included in the analysis. In the 6 studies on adult patients, only patients with respiratory tract infections were investigated. In these studies, a cutoff value of 0.25 μg/L was used, and PCT-guided therapy reduced the number of prescribed antibiotics significantly. Three studies were on pediatric patients, 2 on fever without source and 1 on respiratory complaints. Procalcitonin-guided therapy did not reduce antibiotic prescription in children. Procalcitonin-guided therapy did not result in an increase in adverse events in any of the studies. DISCUSSION: Procalcitonin-guided therapy in the ED is only studied in subpopulations, where it was effective and safe in adult patients with respiratory tract infections and not effective but safe nonetheless in specific pediatric populations. Nonadherence is a significant problem in prospective PCT-guided therapy studies. There is not enough evidence to use PCT-guided therapy in a general ED population.
Authors: Roberta Crevelário de Melo; Bruna Carolina de Araújo; Maritsa Carla de Bortoli; Tereza Setsuko Toma Journal: Rev Panam Salud Publica Date: 2020-09-23
Authors: Sarah Kg Tonkin-Crine; Pui San Tan; Oliver van Hecke; Kay Wang; Nia W Roberts; Amanda McCullough; Malene Plejdrup Hansen; Christopher C Butler; Chris B Del Mar Journal: Cochrane Database Syst Rev Date: 2017-09-07