Document Detail

Effectiveness and safety of procalcitonin-guided antibiotic therapy in lower respiratory tract infections in "real life": an international, multicenter poststudy survey (ProREAL).
MedLine Citation:
PMID:  22782201     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In controlled studies, procalcitonin (PCT) has safely and effectively reduced antibiotic drug use for lower respiratory tract infections (LRTIs). However, controlled trial data may not reflect real life.
METHODS: We performed an observational quality surveillance in 14 centers in Switzerland, France, and the United States. Consecutive adults with LRTI presenting to emergency departments or outpatient offices were enrolled and registered on a website, which provided a previously published PCT algorithm for antibiotic guidance. The primary end point was duration of antibiotic therapy within 30 days.
RESULTS: Of 1759 patients, 86.4% had a final diagnosis of LRTI (community-acquired pneumonia, 53.7%; acute exacerbation of chronic obstructive pulmonary disease, 17.1%; and bronchitis, 14.4%). Algorithm compliance overall was 68.2%, with differences between diagnoses (bronchitis, 81.0%; AECOPD, 70.1%; and community-acquired pneumonia, 63.7%; P < .001), outpatients (86.1%) and inpatients (65.9%) (P < .001), algorithm-experienced (82.5%) and algorithm-naive (60.1%) centers (P < .001), and countries (Switzerland, 75.8%; France, 73.5%; and the United States, 33.5%; P < .001). After multivariate adjustment, antibiotic therapy duration was significantly shorter if the PCT algorithm was followed compared with when it was overruled (5.9 vs 7.4 days; difference, -1.51 days; 95% CI, -2.04 to -0.98; P < .001). No increase was noted in the risk of the combined adverse outcome end point within 30 days of follow-up when the PCT algorithm was followed regarding withholding antibiotics on hospital admission (adjusted odds ratio, 0.83; 95% CI, 0.44 to 1.55; P = .56) and regarding early cessation of antibiotics (adjusted odds ratio, 0.61; 95% CI, 0.36 to 1.04; P = .07).
CONCLUSIONS: This study validates previous results from controlled trials in real-life conditions and demonstrates that following a PCT algorithm effectively reduces antibiotic use without increasing the risk of complications. Preexisting differences in antibiotic prescribing affect compliance with antibiotic stewardship efforts.
Werner C Albrich; Frank Dusemund; Birgit Bucher; Stefan Meyer; Robert Thomann; Felix Kühn; Stefano Bassetti; Martin Sprenger; Esther Bachli; Thomas Sigrist; Martin Schwietert; Devendra Amin; Pierre Hausfater; Eric Carre; Jacques Gaillat; Philipp Schuetz; Katharina Regez; Rita Bossart; Ursula Schild; Beat Mueller;
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Archives of internal medicine     Volume:  172     ISSN:  1538-3679     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-07-11     Completed Date:  2012-09-21     Revised Date:  2014-07-26    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  715-22     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use*
Calcitonin / therapeutic use*
Controlled Clinical Trials as Topic
Drug Therapy, Combination
Middle Aged
Protein Precursors / therapeutic use*
Respiratory Tract Infections / diagnosis,  drug therapy*
Treatment Outcome
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Protein Precursors; 56645-65-9/procalcitonin; 9007-12-9/Calcitonin
Werner C Albrich / ; Frank Dusemund / ; Birgit Bucher / ; Stefan Meyer / ; Katharine Regez / ; Rita Bossart / ; Ursula Schild / ; Beat Mueller / ; Marcus Batschwaroff / ; Birsen Arici / ; Alexander Litke / ; Ulrich Bürgi / ; Andreas Huber / ; Sarosh Irani / ; Renate Hunziker / ; Robert Thomann / ; Felix Kühn / ; Stefano Bassetti / ; Martin Sprenger / ; Ester Bachli / ; Alexander Spillmann / ; Slavka Kraljevic / ; Martin Schwietert / ; Werner Zimmerli / ; Thomas Sigrist / ; Martin Frey / ; Daniel Rodriguez / ; Devendra Amin / ; Philipp Schuetz / ; Piere Hausfater / ; Viviane Montout / ; Beatrice Madonna-Py / ; Eric Carre / ; Jacques Gaillat / ; Gaëlle Pillaut /
Comment In:
Arch Intern Med. 2012 May 14;172(9):722-3   [PMID:  22782202 ]
Erratum In:
Arch Intern Med. 2014 Jun;174(6):1011

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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