The real life application of a procalcitonin-based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia: a proof of concept
Community-acquired pneumonia (CAP) represents a common cause of hospitalization in Internal Medicine wards and a frequent cause of antibiotic prescription. An approach based on procalcitonin (PCT) algorithm, has shown to reduce the antibiotic exposure without affecting outcome, in patients admitted...
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2016-09-01
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| Series: | Italian Journal of Medicine |
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| Online Access: | http://www.italjmed.org/index.php/ijm/article/view/643 |
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| author | Filippo Pieralli Vieri Vannucchi Maria Vittoria Silverii Ezilda Ricci Elena Fissi Antonio Mancini Francesca Bacci Carlo Nozzoli |
| author_facet | Filippo Pieralli Vieri Vannucchi Maria Vittoria Silverii Ezilda Ricci Elena Fissi Antonio Mancini Francesca Bacci Carlo Nozzoli |
| author_sort | Filippo Pieralli |
| collection | DOAJ |
| description | Community-acquired pneumonia (CAP) represents a common cause of hospitalization in Internal Medicine wards and a frequent cause of antibiotic prescription. An approach based on procalcitonin (PCT) algorithm, has shown to reduce the antibiotic exposure without affecting outcome, in patients admitted to hospital for pneumonia We conducted a study to evaluate the role of a PCT algorithm in a <em>real-life</em> perspective, to reduce the length of antibiotic treatment (AT) in patients hospitalized with CAP. We performed a prospective case-control study, enrolling patients with CAP admitted to an Internal Medicine ward of Careggi Hospital, between December 2013 and February 2014. We used a validated algorithm of AT guided by PCT in CAP. Discontinuation of AT was strongly indicated when PCT level was normal or reduced by 80% in patients with PCT values higher than 10 pg/mL on admission. PCT was drawn on admission, 24 h, 4<sup>th</sup> day and 6<sup>th</sup> day from admission. The outcomes evaluated were the length of AT, the length of in hospital stay, mortality and serious adverse clinical events. Forty-six patients were consecutively enrolled. On 20 patients, AT was discontinued according to protocol and on 26 patients the AT was continued on clinical judgement. At the baseline, both groups were similar regarding clinical, laboratory, microbiology characteristics, and CURB-65 score. PCT guidance reduced total antibiotic exposure (5.1±1.5 <em>vs</em> 9.1±5.8 days, P=0.005) without any increase of mortality or serious clinical event. In our study, a PCT algorithm was a useful and safe tool to guide the AT in patients with CAP, reducing the antibiotic exposure. |
| first_indexed | 2024-03-09T07:40:18Z |
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| issn | 1877-9344 1877-9352 |
| language | English |
| last_indexed | 2024-03-09T07:40:18Z |
| publishDate | 2016-09-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Italian Journal of Medicine |
| spelling | doaj.art-6aac4743530542cab7ba745409d0fd542023-12-03T04:55:28ZengPAGEPress PublicationsItalian Journal of Medicine1877-93441877-93522016-09-0110321321810.4081/itjm.2016.643574The real life application of a procalcitonin-based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia: a proof of conceptFilippo Pieralli0Vieri Vannucchi1Maria Vittoria Silverii2Ezilda Ricci3Elena Fissi4Antonio Mancini5Francesca Bacci6Carlo Nozzoli7Department of Medicine for the Complexity of Care 1, University Hospital of Careggi, FirenzeDepartment of Medicine for the Complexity of Care 1, University Hospital of Careggi, FirenzeDepartment of Medicine for the Complexity of Care 1, University Hospital of Careggi, FirenzeDepartment of Medicine for the Complexity of Care 1, University Hospital of Careggi, FirenzeDepartment of Medicine for the Complexity of Care 1, University Hospital of Careggi, FirenzeDepartment of Medicine for the Complexity of Care 1, University Hospital of Careggi, FirenzeDepartment of Medicine for the Complexity of Care 1, University Hospital of Careggi, FirenzeDepartment of Medicine for the Complexity of Care 1, University Hospital of Careggi, FirenzeCommunity-acquired pneumonia (CAP) represents a common cause of hospitalization in Internal Medicine wards and a frequent cause of antibiotic prescription. An approach based on procalcitonin (PCT) algorithm, has shown to reduce the antibiotic exposure without affecting outcome, in patients admitted to hospital for pneumonia We conducted a study to evaluate the role of a PCT algorithm in a <em>real-life</em> perspective, to reduce the length of antibiotic treatment (AT) in patients hospitalized with CAP. We performed a prospective case-control study, enrolling patients with CAP admitted to an Internal Medicine ward of Careggi Hospital, between December 2013 and February 2014. We used a validated algorithm of AT guided by PCT in CAP. Discontinuation of AT was strongly indicated when PCT level was normal or reduced by 80% in patients with PCT values higher than 10 pg/mL on admission. PCT was drawn on admission, 24 h, 4<sup>th</sup> day and 6<sup>th</sup> day from admission. The outcomes evaluated were the length of AT, the length of in hospital stay, mortality and serious adverse clinical events. Forty-six patients were consecutively enrolled. On 20 patients, AT was discontinued according to protocol and on 26 patients the AT was continued on clinical judgement. At the baseline, both groups were similar regarding clinical, laboratory, microbiology characteristics, and CURB-65 score. PCT guidance reduced total antibiotic exposure (5.1±1.5 <em>vs</em> 9.1±5.8 days, P=0.005) without any increase of mortality or serious clinical event. In our study, a PCT algorithm was a useful and safe tool to guide the AT in patients with CAP, reducing the antibiotic exposure.http://www.italjmed.org/index.php/ijm/article/view/643Procalcitonincommunity-acquired pneumoniaantibiotic therapy. |
| spellingShingle | Filippo Pieralli Vieri Vannucchi Maria Vittoria Silverii Ezilda Ricci Elena Fissi Antonio Mancini Francesca Bacci Carlo Nozzoli The real life application of a procalcitonin-based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia: a proof of concept Italian Journal of Medicine Procalcitonin community-acquired pneumonia antibiotic therapy. |
| title | The real life application of a procalcitonin-based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia: a proof of concept |
| title_full | The real life application of a procalcitonin-based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia: a proof of concept |
| title_fullStr | The real life application of a procalcitonin-based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia: a proof of concept |
| title_full_unstemmed | The real life application of a procalcitonin-based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia: a proof of concept |
| title_short | The real life application of a procalcitonin-based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia: a proof of concept |
| title_sort | real life application of a procalcitonin based algorithm to reduce antibiotic exposure in hospitalized patients with community acquired pneumonia a proof of concept |
| topic | Procalcitonin community-acquired pneumonia antibiotic therapy. |
| url | http://www.italjmed.org/index.php/ijm/article/view/643 |
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