Francesco Alessandri1,2, Francesco Pugliese1,2, Silvia Angeletti3, Massimo Ciccozzi4, Alessandro Russo5, Claudio M Mastroianni2,6, Gabriella d'Ettorre2,6, Mario Venditti2,6, Giancarlo Ceccarelli7,8. 1. Department of Anaesthesia and Critical Care Medicine, University of Rome "Sapienza", Rome, Italy. 2. Azienda Policlinico Umberto I, Rome, Italy. 3. Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy. 4. Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy. 5. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 6. Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy. 7. Azienda Policlinico Umberto I, Rome, Italy. giancarlo.ceccarelli@uniroma1.it. 8. Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Rome, Italy. giancarlo.ceccarelli@uniroma1.it.
Abstract
BACKGROUND: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infection, associated with considerable mortality and morbidity in critically ill patients; however, its diagnosis and management remain challenging since clinical assessment is often poorly reliable. The aim of this systematic review was to evaluate the role of PCT in the diagnosis and management of critical ill patients affected by VAP. METHODS: We performed a systematic review of the evidence published over the last 10 years and currently available in medical literature search databases (Pubmed, Embase, Web of Knowledge, Cochrane Libraries) and searching clinical trial registries. We regarded as predefined outcomes the role of PCT in diagnosis, therapeutic monitoring, antibiotic discontinuation and prognosis. The Open Science Framework Registration number was doi.org/10.17605/OSF. IO/ZGFKQ RESULTS: 761 articles were retrieved and a total of 18 studies (n° of patients = 1774) were selected and analyzed according to inclusion criteria. In this 2020 update, the systematic review showed that currently, conflicting and inconclusive data are available about the role of PCT in the diagnosis of VAP and in the prediction (i) of the efficacy of antibiotic therapy, and (ii) of the clinical outcome. These studies, instead, seem to agree on the utility of PCT in the management of antibiotic therapy discontinuation. CONCLUSIONS: Currently there is insufficient evidence to support the role of PCT in the routine assessment of patients with VAP. The value of the results published appears to be limited by the deep methodological differences that characterize the various studies available at the present being.
BACKGROUND: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infection, associated with considerable mortality and morbidity in critically illpatients; however, its diagnosis and management remain challenging since clinical assessment is often poorly reliable. The aim of this systematic review was to evaluate the role of PCT in the diagnosis and management of critical ill patients affected by VAP. METHODS: We performed a systematic review of the evidence published over the last 10 years and currently available in medical literature search databases (Pubmed, Embase, Web of Knowledge, Cochrane Libraries) and searching clinical trial registries. We regarded as predefined outcomes the role of PCT in diagnosis, therapeutic monitoring, antibiotic discontinuation and prognosis. The Open Science Framework Registration number was doi.org/10.17605/OSF. IO/ZGFKQ RESULTS: 761 articles were retrieved and a total of 18 studies (n° of patients = 1774) were selected and analyzed according to inclusion criteria. In this 2020 update, the systematic review showed that currently, conflicting and inconclusive data are available about the role of PCT in the diagnosis of VAP and in the prediction (i) of the efficacy of antibiotic therapy, and (ii) of the clinical outcome. These studies, instead, seem to agree on the utility of PCT in the management of antibiotic therapy discontinuation. CONCLUSIONS: Currently there is insufficient evidence to support the role of PCT in the routine assessment of patients with VAP. The value of the results published appears to be limited by the deep methodological differences that characterize the various studies available at the present being.
Authors: J Y Fagon; J Chastre; M Wolff; C Gervais; S Parer-Aubas; F Stéphan; T Similowski; A Mercat; J L Diehl; J P Sollet; A Tenaillon Journal: Ann Intern Med Date: 2000-04-18 Impact factor: 25.391
Authors: Sara F Habib; Ahmed M Mukhtar; Hossam M Abdelreheem; Mervat M Khorshied; Riham El Sayed; Mohamed H Hafez; Heba M Gouda; Doaa M Ghaith; Ahmed Mohamed Hasanin; Akram S Eladawy; Mai A Ali; Ahmed Z Fouad Journal: Clin Chem Lab Med Date: 2016-05 Impact factor: 3.694
Authors: Vimal Grover; Panagiotis Pantelidis; Neil Soni; Masao Takata; Pallav L Shah; Athol U Wells; Don C Henderson; Peter Kelleher; Suveer Singh Journal: PLoS One Date: 2014-10-07 Impact factor: 3.240