Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease
Acute chest syndrome (ACS) is a major complication of sickle-cell disease. Bacterial infection is one cause of ACS, so current guidelines recommend the routine use of antibiotics. We performed a prospective before–after study in medical wards and an intensive-care unit (ICU). During the control phas...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/11/3718 |
| _version_ | 1797547444560461824 |
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| author | Keyvan Razazi Ségolène Gendreau Elise Cuquemelle Mehdi Khellaf Constance Guillaud Bertrand Godeau Giovanna Melica Stéphane Moutereau Camille Gomart Slim Fourati Nicolas De Prost Guillaume Carteaux Christian Brun-Buisson Pablo Bartolucci Anoosha Habibi Armand Mekontso Dessap |
| author_facet | Keyvan Razazi Ségolène Gendreau Elise Cuquemelle Mehdi Khellaf Constance Guillaud Bertrand Godeau Giovanna Melica Stéphane Moutereau Camille Gomart Slim Fourati Nicolas De Prost Guillaume Carteaux Christian Brun-Buisson Pablo Bartolucci Anoosha Habibi Armand Mekontso Dessap |
| author_sort | Keyvan Razazi |
| collection | DOAJ |
| description | Acute chest syndrome (ACS) is a major complication of sickle-cell disease. Bacterial infection is one cause of ACS, so current guidelines recommend the routine use of antibiotics. We performed a prospective before–after study in medical wards and an intensive-care unit (ICU). During the control phase, clinicians were blinded to procalcitonin concentration results. We built an algorithm using the obtained measurements to hasten antibiotic cessation after three days of treatment if bacterial infection was not documented, and procalcitonin concentrations were all <0.5 μg/L. During the intervention period, the procalcitonin algorithm was suggested to physicians as a guide for antibiotic therapy. The primary endpoint was the number of days alive without antibiotics at Day 21. One-hundred patients were analyzed (103 ACS episodes, 60 in intervention phase). Possible or proven lung infection was diagnosed during 13% of all ACS episodes. The number of days alive without antibiotics at Day 21 was higher during the intervention phase: 15 [14–18] vs. 13 [13,14] days (<i>p</i> = 0.001). More patients had a short (≤3 days) antibiotic course during intervention phase: 31% vs 9% (<i>p</i> = 0.01). There was neither infection relapse nor pulmonary superinfection in the entire cohort. A procalcitonin-guided strategy to prescribe antibiotics in patients with ACS may reduce antibiotic exposure with no apparent adverse outcomes. |
| first_indexed | 2024-03-10T14:44:13Z |
| format | Article |
| id | doaj.art-c2c0f96109bd4e7ba391b098167af5c4 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T14:44:13Z |
| publishDate | 2020-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-c2c0f96109bd4e7ba391b098167af5c42023-11-20T21:34:43ZengMDPI AGJournal of Clinical Medicine2077-03832020-11-01911371810.3390/jcm9113718Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell DiseaseKeyvan Razazi0Ségolène Gendreau1Elise Cuquemelle2Mehdi Khellaf3Constance Guillaud4Bertrand Godeau5Giovanna Melica6Stéphane Moutereau7Camille Gomart8Slim Fourati9Nicolas De Prost10Guillaume Carteaux11Christian Brun-Buisson12Pablo Bartolucci13Anoosha Habibi14Armand Mekontso Dessap15DHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, FranceDHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, FranceDHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, FranceService d’Accueil des Urgences, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceDépartement d’Aval des Urgences, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceService de Médecine Interne, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceService d’Immunologie Clinique et Maladies Infectieuses, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceService de Biochimie, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceDépartement de Virologie, Bactériologie, Parasitologie-Mycologie, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceDépartement de Virologie, Bactériologie, Parasitologie-Mycologie, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceDHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, FranceDHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, FranceDHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, FranceUnité U955, INSERM, Université Paris Est, 94010 Créteil, FranceUnité U955, INSERM, Université Paris Est, 94010 Créteil, FranceDHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, FranceAcute chest syndrome (ACS) is a major complication of sickle-cell disease. Bacterial infection is one cause of ACS, so current guidelines recommend the routine use of antibiotics. We performed a prospective before–after study in medical wards and an intensive-care unit (ICU). During the control phase, clinicians were blinded to procalcitonin concentration results. We built an algorithm using the obtained measurements to hasten antibiotic cessation after three days of treatment if bacterial infection was not documented, and procalcitonin concentrations were all <0.5 μg/L. During the intervention period, the procalcitonin algorithm was suggested to physicians as a guide for antibiotic therapy. The primary endpoint was the number of days alive without antibiotics at Day 21. One-hundred patients were analyzed (103 ACS episodes, 60 in intervention phase). Possible or proven lung infection was diagnosed during 13% of all ACS episodes. The number of days alive without antibiotics at Day 21 was higher during the intervention phase: 15 [14–18] vs. 13 [13,14] days (<i>p</i> = 0.001). More patients had a short (≤3 days) antibiotic course during intervention phase: 31% vs 9% (<i>p</i> = 0.01). There was neither infection relapse nor pulmonary superinfection in the entire cohort. A procalcitonin-guided strategy to prescribe antibiotics in patients with ACS may reduce antibiotic exposure with no apparent adverse outcomes.https://www.mdpi.com/2077-0383/9/11/3718sickle-cell diseaseacute chest syndromeprocalcitoninantibioticbacterial infection |
| spellingShingle | Keyvan Razazi Ségolène Gendreau Elise Cuquemelle Mehdi Khellaf Constance Guillaud Bertrand Godeau Giovanna Melica Stéphane Moutereau Camille Gomart Slim Fourati Nicolas De Prost Guillaume Carteaux Christian Brun-Buisson Pablo Bartolucci Anoosha Habibi Armand Mekontso Dessap Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease Journal of Clinical Medicine sickle-cell disease acute chest syndrome procalcitonin antibiotic bacterial infection |
| title | Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease |
| title_full | Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease |
| title_fullStr | Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease |
| title_full_unstemmed | Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease |
| title_short | Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease |
| title_sort | procalcitonin to reduce antibiotic exposure during acute chest syndrome in adult patients with sickle cell disease |
| topic | sickle-cell disease acute chest syndrome procalcitonin antibiotic bacterial infection |
| url | https://www.mdpi.com/2077-0383/9/11/3718 |
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