1
|
Huang J, Zu Y, Zhang L, Cui W. Progress in Procalcitonin Detection Based on Immunoassay. RESEARCH (WASHINGTON, D.C.) 2024; 7:0345. [PMID: 38711476 PMCID: PMC11070848 DOI: 10.34133/research.0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/04/2024] [Indexed: 05/08/2024]
Abstract
Procalcitonin (PCT) serves as a crucial biomarker utilized in diverse clinical contexts, including sepsis diagnosis and emergency departments. Its applications extend to identifying pathogens, assessing infection severity, guiding drug administration, and implementing theranostic strategies. However, current clinical deployed methods cannot meet the needs for accurate or real-time quantitative monitoring of PCT. This review aims to introduce these emerging PCT immunoassay technologies, focusing on analyzing their advantages in improving detection performances, such as easy operation and high precision. The fundamental principles and characteristics of state-of-the-art methods are first introduced, including chemiluminescence, immunofluorescence, latex-enhanced turbidity, enzyme-linked immunosorbent, colloidal gold immunochromatography, and radioimmunoassay. Then, improved methods using new materials and new technologies are briefly described, for instance, the combination with responsive nanomaterials, Raman spectroscopy, and digital microfluidics. Finally, the detection performance parameters of these methods and the clinical importance of PCT detection are also discussed.
Collapse
Affiliation(s)
- Jiayue Huang
- State Key Laboratory of Targeting Oncology, National Center for International Research of Bio-targeting Theranostics, Guangxi Key Laboratory of Bio-targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy,
Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Yan Zu
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health); Wenzhou Institute,
University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325000, P.R. China
| | - Lexiang Zhang
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health); Wenzhou Institute,
University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325000, P.R. China
- Joint Centre of Translational Medicine,
the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, P.R. China
| | - Wenguo Cui
- State Key Laboratory of Targeting Oncology, National Center for International Research of Bio-targeting Theranostics, Guangxi Key Laboratory of Bio-targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy,
Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases,
Shanghai Institute of Traumatology and Orthopedics,Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P.R. China
| |
Collapse
|
2
|
Zaki HA, Bensliman S, Bashir K, Iftikhar H, Fayed MH, Salem W, Elmoheen A, Yigit Y. Accuracy of procalcitonin for diagnosing sepsis in adult patients admitted to the emergency department: a systematic review and meta-analysis. Syst Rev 2024; 13:37. [PMID: 38254218 PMCID: PMC10802075 DOI: 10.1186/s13643-023-02432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Differentiating sepsis from non-infectious systemic inflammatory response syndrome (SIRS) is challenging. Biomarkers like procalcitonin (PCT) aid early risk assessment and guide antibiotic use. This study aims to ascertain PCT's accuracy as a sepsis biomarker among adult emergency department admissions. METHOD The PRISMA guidelines were followed to search for relevant articles in five electronic databases between April 14th and August 4th, 2023: PubMed, Cochrane Library, ProQuest, EMBASEs, and ScienceDirect. Studies had to be published in English to avoid directly translating scientific terms. Besides, the inclusion criteria were based on the diagnosis of sepsis in adult patients admitted to an emergency department. QUADAS-2 tool provided by the Review Manager version 5.4.1 was utilized to assess the risk of bias in included studies. STATA (v. 16) software was used to perform the meta-analysis. RESULTS Ten of 2457 studies were included. We sampled 2980 adult sepsis patients for the under-investigated role of PCT in ED sepsis diagnosis. PCT emerged as the primary early diagnostic biomarker with high levels (29.3 ± 85.3 ng/mL) in sepsis patients. Heterogeneity in outcomes, possibly due to bias in cohort and observational studies, was observed. CONCLUSION PCT tests offer moderate accuracy in diagnosing sepsis and stand out for rapidly and precisely distinguishing between viral and bacterial inflammations.
Collapse
Affiliation(s)
- Hany A Zaki
- Hamad Medical Corporation Doha, Ar-Rayyan, Qatar
| | | | - Khalid Bashir
- Hamad Medical Corporation Doha, Ar-Rayyan, Qatar
- Medicine, Qatar University, Doha, Qatar
| | | | | | - Waleed Salem
- Hamad Medical Corporation Doha, Ar-Rayyan, Qatar
| | - Amr Elmoheen
- Hamad Medical Corporation Doha, Ar-Rayyan, Qatar
- Medicine, Qatar University, Doha, Qatar
| | - Yavuz Yigit
- Hamad Medical Corporation Doha, Ar-Rayyan, Qatar.
- Blizard Institute, Queen Mary University, London, UK.
| |
Collapse
|
3
|
Falcone M, Bauer M, Ferrer R, Gavazzi G, Gonzalez Del Castillo J, Pilotto A, Schuetz P. Biomarkers for risk stratification and antibiotic stewardship in elderly patients. Aging Clin Exp Res 2023; 35:925-935. [PMID: 36995460 PMCID: PMC10060920 DOI: 10.1007/s40520-023-02388-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Optimal treatment of infections in the elderly patients population is challenging because clinical symptoms and signs may be less specific potentially resulting in both, over- and undertreatment. Elderly patients also have a less pronounced immune response to infection, which may influence kinetics of biomarkers of infection. METHODS Within a group of experts, we critically reviewed the current literature regarding biomarkers for risk stratification and antibiotic stewardship in elderly patients with emphasis on procalcitonin (PCT). RESULTS The expert group agreed that there is strong evidence that the elderly patient population is particularly vulnerable for infections and due to ambiguity of clinical signs and parameters in the elderly, there is considerable risk for undertreatment. At the same time, however, this group of patients is particularly vulnerable for off-target effects from antibiotic treatment and limiting the use of antibiotics is therefore important. The use of infection markers including PCT to guide individual treatment decisions has thus particular appeal in geriatric patients. For the elderly, there is evidence that PCT is a valuable biomarker for assessing the risk of septic complications and adverse outcomes, and helpful for guiding individual decisions for or against antibiotic treatment. There is need for additional educational efforts regarding the concept of "biomarker-guided antibiotic stewardship" for health care providers caring for elderly patients. CONCLUSION Use of biomarkers, most notably PCT, has high potential to improve the antibiotic management of elderly patients with possible infection for improving both, undertreatment and overtreatment. Within this narrative review, we aim to provide evidence-based concepts for the safe and efficient use of PCT in elderly patients.
Collapse
Affiliation(s)
- Marco Falcone
- Department of Infectious Diseases, Pisa University Hospital, Pisa, Italy
| | - Michael Bauer
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Ricard Ferrer
- Intensive Care Department, Hospital Universitari Vall d'Hebron, SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Gaëtan Gavazzi
- Clinical Geriatrics Unit, Grenoble University Hospital, Grenoble, France
| | - Juan Gonzalez Del Castillo
- Department of Emergency Medicine, Clínico San Carlos Hospital, IdISSC, Complutense University, Madrid, Spain
| | - Alberto Pilotto
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
- Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
| | - Philipp Schuetz
- Internal Medicine and Emergency Medicine, Aarau Hospital, Aarau, Switzerland.
| |
Collapse
|
4
|
Flamant L, Giordano Orsini G, Ramont L, Gornet M, De Ruffi S, Leroux P, Kanagaratnam L, Gennai S. Association between admission biomarkers and clinical outcome in older adults diagnosed with an infection in the emergency department. Acta Clin Belg 2022:1-6. [DOI: 10.1080/17843286.2022.2146929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lucas Flamant
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | | | - Laurent Ramont
- Biochemistry Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
- Université de Reims Champagne-Ardenne, CHU Reims, SFR CAP-Santé, Reims, France
| | - Marion Gornet
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Sebastien De Ruffi
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Pierre Leroux
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Lukshe Kanagaratnam
- Clinical Research Unit, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
| | - Stéphane Gennai
- Emergency Department, Reims University Hospital, 45 rue Cognacq-Jay, 51100, Reims, France
- Université de Reims Champagne-Ardenne, CHU Reims, INSERM, P3Cell, U 1250, Reims, France
| |
Collapse
|
5
|
Murphy CV, Reed EE, Herman DD, Magrum B, Beatty JJ, Stevenson KB. Antimicrobial Stewardship in the ICU. Semin Respir Crit Care Med 2022; 43:131-140. [PMID: 35172363 DOI: 10.1055/s-0041-1740977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Increasing rates of infection and multidrug-resistant pathogens, along with a high use of antimicrobial therapy, make the intensive care unit (ICU) an ideal setting for implementing and supporting antimicrobial stewardship efforts. Overuse of antimicrobial agents is common in the ICU, as practitioners are challenged daily with achieving early, appropriate empiric antimicrobial therapy to improve patient outcomes. While early antimicrobial stewardship programs focused on the financial implications of antimicrobial overuse, current goals of stewardship programs align closely with those of critical care providers-to optimize patient outcomes, reduce development of resistance, and minimize adverse outcomes associated with antibiotic overuse and misuse such as acute kidney injury and Clostridioides difficile-associated disease. Significant opportunities exist in the ICU for critical care clinicians to support stewardship practices at the bedside, including thoughtful and restrained initiation of antimicrobial therapy, use of biomarkers in addition to rapid diagnostics, Staphylococcus aureus screening, and traditional microbiologic culture and susceptibilities to guide antibiotic de-escalation, and use of the shortest duration of therapy that is clinically appropriate. Integration of critical care practitioners into the initiatives of antimicrobial stewardship programs is key to their success. This review summarizes key components of antimicrobial stewardship programs and mechanisms for critical care practitioners to share the responsibility for antimicrobial stewardship.
Collapse
Affiliation(s)
- Claire V Murphy
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Erica E Reed
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Derrick D Herman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - BrookeAnne Magrum
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Julia J Beatty
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kurt B Stevenson
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| |
Collapse
|
6
|
Li M, Ren R, Yan M, Chen S, Chen C, Yan J. Identification of novel biomarkers for sepsis diagnosis via serum proteomic analysis using iTRAQ-2D-LC-MS/MS. J Clin Lab Anal 2021; 36:e24142. [PMID: 34825737 PMCID: PMC8761403 DOI: 10.1002/jcla.24142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/06/2021] [Accepted: 11/13/2021] [Indexed: 11/09/2022] Open
Abstract
Background Sepsis is a common cause of morbidity and mortality in the ICU patients. Early diagnosis and appropriate patient management is the key to improve the patient survival and to limit disabilities in sepsis patients. This study was aimed to find new diagnostic biomarkers of sepsis. Methods In this study, serum proteomic profiles in sepsis patients by iTRAQ2D‐LC‐MS/MS. Thirty seven differentially expressed proteins were identified in patients with sepsis, and six proteins including ApoC3, SERPINA1, VCAM1, B2M, GPX3, and ApoE were selected for further verification by ELISA and immunoturbidimetry in 53 patients of non‐sepsis, 37 patients of sepsis, and 35 patients of septic shock. Descriptive statistics, functional enrichment analysis, and ROC curve analysis were conducted. Results The level of ApoC3 was gradually decreased among non‐sepsis, sepsis, and septic shock groups (p = 0.049). The levels of VCAM1 (p = 0.010), B2M (p = 0.004), and ApoE (p = 0.039) were showing an increased tread in three groups, with the peak values of B2M and ApoE in the sepsis group. ROC curve analysis for septic diagnosis showed that the areas under ROC curve (AUC) of ApoC3, VCAM1, B2M, and ApoE were 0.625, 0.679, 0.581, and 0.619, respectively, which were lower than that of PCT (AUC 0.717) and CRP (AUC 0.706), but there were no significant differences between each index and PCT or CRP. The combination including four validated indexes and two classical infection indexes for septic diagnosis had the highest AUC‐ROC of 0.772. Conclusion Proteins of ApoC3, VCAM1, B2M, and ApoE provide a supplement to classical biomarkers for septic diagnosis.
Collapse
Affiliation(s)
- Meng Li
- Department of Clinical Laboratory, Zhejiang Hospital, Hangzhou, China
| | - Rongrong Ren
- Department of Clinical Laboratory, Zhejiang Hospital, Hangzhou, China
| | - Molei Yan
- Department of Intensive Care, Zhejiang Hospital, Hangzhou, China
| | - Shangzhong Chen
- Department of Intensive Care, Zhejiang Hospital, Hangzhou, China
| | - Chen Chen
- Department of Clinical Laboratory, Zhejiang Hospital, Hangzhou, China
| | - Jing Yan
- Department of Intensive Care, Zhejiang Hospital, Hangzhou, China
| |
Collapse
|
7
|
Heilmann E, Gregoriano C, Annane D, Reinhart K, Bouadma L, Wolff M, Chastre J, Luyt CE, Tubach F, Branche AR, Briel M, Christ-Crain M, Welte T, Corti C, de Jong E, Nijsten M, de Lange DW, van Oers JAH, Beishuizen A, Girbes ARJ, Deliberato RO, Schroeder S, Kristoffersen KB, Layios N, Damas P, Lima SSS, Nobre V, Wei L, Oliveira CF, Shehabi Y, Stolz D, Tamm M, Verduri A, Wang JX, Drevet S, Gavazzi G, Mueller B, Schuetz P. Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials. Age Ageing 2021; 50:1546-1556. [PMID: 33993243 PMCID: PMC8437072 DOI: 10.1093/ageing/afab078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background Older patients have a less pronounced immune response to infection, which may also influence infection biomarkers. There is currently insufficient data regarding clinical effects of procalcitonin (PCT) to guide antibiotic treatment in older patients. Objective and design We performed an individual patient data meta-analysis to investigate the association of age on effects of PCT-guided antibiotic stewardship regarding antibiotic use and outcome. Subjects and methods We had access to 9,421 individual infection patients from 28 randomized controlled trials comparing PCT-guided antibiotic therapy (intervention group) or standard care. We stratified patients according to age in four groups (<75 years [n = 7,079], 75–80 years [n = 1,034], 81–85 years [n = 803] and >85 years [n = 505]). The primary endpoint was the duration of antibiotic treatment and the secondary endpoints were 30-day mortality and length of stay. Results Compared to control patients, mean duration of antibiotic therapy in PCT-guided patients was significantly reduced by 24, 22, 26 and 24% in the four age groups corresponding to adjusted differences in antibiotic days of −1.99 (95% confidence interval [CI] −2.36 to −1.62), −1.98 (95% CI −2.94 to −1.02), −2.20 (95% CI −3.15 to −1.25) and − 2.10 (95% CI −3.29 to −0.91) with no differences among age groups. There was no increase in the risk for mortality in any of the age groups. Effects were similar in subgroups by infection type, blood culture result and clinical setting (P interaction >0.05). Conclusions This large individual patient data meta-analysis confirms that, similar to younger patients, PCT-guided antibiotic treatment in older patients is associated with significantly reduced antibiotic exposures and no increase in mortality.
Collapse
Affiliation(s)
- Eva Heilmann
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
- Departement of Oncology, Kantonsspital Aarau, Aarau, Switzerland
| | - Claudia Gregoriano
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
- Departement of Oncology, Kantonsspital Aarau, Aarau, Switzerland
| | - Djillali Annane
- Department of Critical Care, Hyperbaric Medicine and Home Respiratory Unit, Center for Neuromuscular Diseases, Raymond Poincaré Hospital (AP-HP), Garches, France
| | - Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Lila Bouadma
- Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Univeersité Paris 7-Denis-Diderot, Paris, France
| | - Michel Wolff
- Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Univeersité Paris 7-Denis-Diderot, Paris, France
| | - Jean Chastre
- Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Univeersité Paris 7-Denis-Diderot, Paris, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Florence Tubach
- Département d’Epidémiologie Biostatistique et Recherche Clinique, AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Angela R Branche
- Department of Medicine, Rochester General Hospital, New York, NY, USA
| | - Matthias Briel
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Mirjam Christ-Crain
- Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
| | - Tobias Welte
- Department of Pulmonary Medicine, Medizinische Hochschule Hannover, Hannover, Germany
| | - Caspar Corti
- Department of Respiratory Medicine, Hospital Bispebjerg, Copenhagen University, Copenhagen, Denmark
| | - Evelien de Jong
- Department of Intensive Care, VU University Medical Center, Amsterdam, the Netherlands
| | - Maarten Nijsten
- University Medical Centre, University of Groningen, Groningen, the Netherlands
| | | | - Jos A H van Oers
- Department of Intensive Care Medicine, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands
| | | | - Armand R J Girbes
- Department of Intensive Care, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Stefan Schroeder
- Department of Anesthesiology and Intensive Care Medicine, Krankenhaus Dueren, Dueren, Germany
| | | | - Nathalie Layios
- Department of General Intensive Care, University Hospital of Liege, Domaine Universitaire de Liège, Liege, Belgium
| | - Pierre Damas
- Department of General Intensive Care, University Hospital of Liege, Domaine Universitaire de Liège, Liege, Belgium
| | - Stella S S Lima
- Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vandack Nobre
- Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Long Wei
- Department of Medicine, Shanghai Fifth People’s Hospital, Shanghai, China
| | - Carolina F Oliveira
- Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Yahya Shehabi
- Critical Care and Peri-operative Medicine, Monash Health, Melbourne, Australia
- Faculty of Medicine Nursing and Health Sciences, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Daiana Stolz
- Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Michael Tamm
- Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Alessia Verduri
- Department of Medical and Surgical Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Jin-Xiang Wang
- Department of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Sabine Drevet
- University Clinics of Geriatrics, University Hospital of Grenoble-Alpes, GREPI TIMC-IMAG CNRS 5525 University of Grenoble Alpes, Grenoble, France
| | - Gaetan Gavazzi
- University Clinics of Geriatrics, University Hospital of Grenoble-Alpes, GREPI TIMC-IMAG CNRS 5525 University of Grenoble Alpes, Grenoble, France
| | - Beat Mueller
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| |
Collapse
|
8
|
|
9
|
Lee CC, Kwa ALH, Apisarnthanarak A, Feng JY, Gluck EH, Ito A, Karuniawati A, Periyasamy P, Pratumvinit B, Sharma J, Solante R, Swaminathan S, Tyagi N, Vu DM, Zirpe K, Schuetz P. Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries: adaptation based on an expert consensus meeting. Clin Chem Lab Med 2021; 58:1983-1991. [PMID: 31926074 DOI: 10.1515/cclm-2019-1122] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023]
Abstract
Introduction Recently, an expert consensus on optimal use of procalcitonin (PCT)-guided antibiotic stewardship was published focusing mainly on Europe and the United States. However, for Asia-Pacific countries, recommendations may need adaptation due to differences in types of infections, available resources and standard of clinical care. Methods Practical experience with PCT-guided antibiotic stewardship was discussed among experts from different countries, reflecting on the applicability of the proposed Berlin consensus algorithms for Asia-Pacific. Using a Delphi process, the group reached consensus on two PCT algorithms for the critically ill and the non-critically ill patient populations. Results The group agreed that the existing evidence for PCT-guided antibiotic stewardship in patients with acute respiratory infections and sepsis is generally valid also for Asia-Pacific countries, in regard to proposed PCT cut-offs, emphasis on diagnosis, prognosis and antibiotic stewardship, overruling criteria and inevitable adaptations to clinical settings. However, the group noted an insufficient database on patients with tropical diseases currently limiting the clinical utility in these patients. Also, due to lower resource availabilities, biomarker levels may be measured less frequently and only when changes in treatment are highly likely. Conclusions Use of PCT to guide antibiotic stewardship in conjunction with continuous education and regular feedback to all stakeholders has high potential to improve the utilization of antibiotic treatment also in Asia-Pacific countries. However, there is need for adaptations of existing algorithms due to differences in types of infections and routine clinical care. Further research is needed to understand the optimal use of PCT in patients with tropical diseases.
Collapse
Affiliation(s)
- Chien-Chang Lee
- National Taiwan University Hospital, Emergency Medicine Department and Health Data Science Research Group, Taipei, Taiwan
| | - Andrea Lay Hoon Kwa
- Singapore General Hospital, Singapore, Singapore.,Emerging Infectious Diseases Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | | | - Jia-Yih Feng
- Taipei Veterans General Hospital, Department of Chest Medicine, Taipei, Taiwan
| | | | - Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan
| | - Anis Karuniawati
- Department of Microbiology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Petrick Periyasamy
- Infectious Disease Unit, PPUKM (HCTM), Hospital Canselor Tuanku Muhriz UKM (HCTM), Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia
| | - Busadee Pratumvinit
- Faculty of Medicine Siriraj Hospital, Department of Clinical Pathology, Mahidol University, Bangkok, Thailand
| | | | - Rontgene Solante
- San Lazaro Hospital, Adult Infectious Diseases and Tropical Medicine, Manila, Philippines
| | | | - Niraj Tyagi
- Sir Ganga Ram Hospital, Institute of Critical Care and Emergency Medicine, Delhi, India
| | - Dien Minh Vu
- Critical Care Department, National Hospital of Tropical Diseases, Hanoi, Vietnam
| | - Kapil Zirpe
- Department of Neuro Critical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, India
| | - Philipp Schuetz
- Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.,University of Basel, Basel, Switzerland
| |
Collapse
|
10
|
Meidrops K, Zuravlova A, Osipovs JD, Kalejs M, Groma V, Petrosina E, Reinis A, Strike E, Dumpis U, Erglis A, Stradins P. Comparison of outcome between blood culture positive and negative infective endocarditis patients undergoing cardiac surgery. J Cardiothorac Surg 2021; 16:147. [PMID: 34044847 PMCID: PMC8161995 DOI: 10.1186/s13019-021-01532-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Up to 30% or even more of all infective endocarditis (IE) cases are recognized as blood culture negative, meaning that the causative agent is left unidentified. The prompt diagnosis together with the identification of causative microorganism and targeted antibiotic treatment can significantly impact the prognosis of the disease and further patient’s health status. In some studies, blood culture negative endocarditis has been shown to be associated with delayed diagnosis, worse outcome and course of the disease, and a greater number of intra and postoperative complications. Methods We retrospectively analysed the medical records of all patients who underwent cardiac surgery for endocarditis between years 2016 and 2019. The aim of this study was to analyse short and long-term mortality and differences of laboratory, clinical and echocardiography parameters in patients with blood culture positive endocarditis (BCPE) and blood culture negative endocarditis (BCNE) and its possible impact on the clinical outcome. Results In our study population were 114 (55.1%) blood culture positive and 93 (44.9%) blood culture negative cases of infectious endocarditis. The most common pathogens in the blood culture positive IE group were S.aureus in 36 cases (31.6%), Streptococcus spp. in 27 (23.7%), E.faecalis in 24 (21.1%), and other microorganisms in 27 (23.7%). Embolic events were seen in 60 patients (28.9%). In univariate analyses, detection of microorganism, elevated levels of procalcitonin were found to be significantly associated with intrahospital death, however it did not reach statistical significance in multivariate analyses. Among microorganisms, S.aureus was significantly associated with intrahospital death in both univariate and multivariate analyses. Conclusions There are no statistically significant differences between groups of BCPE and BCNE in terms of intrahospital mortality, hospital and ICU stay or 3-year mortality. There were higher levels of procalcitonin in BCPE group, however procalcitonin failed to show independent association with mortality in multivariate analysis. The most common microorganism in the BCPE group was S.aureus. It was associated with independently higher intrahospital mortality when compared to other causative microorganisms.
Collapse
Affiliation(s)
- Kristians Meidrops
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia. .,Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga, LV-1002, Latvia.
| | - Arina Zuravlova
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia
| | | | - Martins Kalejs
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia.,Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga, LV-1002, Latvia
| | - Valerija Groma
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia
| | - Eva Petrosina
- Statistics Unit, Riga Stradins University, 14 Balozu Street, Riga, LV-1007, Latvia.,Faculty of Physics, Mathematics and Optometry, UL House of Science, University of Latvia, 3 Jelgavas Street, Riga, LV-1004, Latvia
| | - Aigars Reinis
- Department of Biology and Microbiology, Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia
| | - Eva Strike
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia.,Department of Cardiovascular Anaesthesia and Intensive Care, Pauls Stradins Clinical University Hospital, Riga, LV-1002, Latvia
| | - Uga Dumpis
- Department of Infection Control, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga, LV-1002, Latvia
| | - Andrejs Erglis
- Centre of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga, LV-1002, Latvia.,Faculty of Medicine, UL House of Science, University of Latvia, 3 Jelgavas Street, Riga, LV-1004, Latvia
| | - Peteris Stradins
- Riga Stradins University, 16 Dzirciema Street, Riga, LV-1007, Latvia.,Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, Riga, LV-1002, Latvia
| |
Collapse
|
11
|
García de Guadiana-Romualdo L, Morell-García D, Morales-Indiano C, Bauça JM, Alcaide Martín MJ, Esparza del Valle C, Gutiérrez Revilla JI, Urrechaga E, Álamo JM, Hernando Holgado AM, Lorenzo-Lozano MC, Sánchez Fdez-Pacheco S, de la Hera Cagigal P, Juncos Tobarra MA, Vílchez JA, Vírseda Chamorro I, Gutiérrez Garcia I, Pastor Murcia Y, Sahuquillo Frías L, Altimira Queral L, Nuez-Zaragoza E, Adell Ruiz de León J, Ruiz Ripa A, Salas Gómez-Pablos P, Cebreiros López I, Fernández Uriarte A, Larruzea Á, López Yepes ML, Esteban Torrella P, Zamorano Andrés MC, Pedregosa Díaz J, Acevedo Alcaraz C, Blazquez-Manzanera AL, Padilla Jiménez AML, Baamonde Calzada MC, Vera M, Cháfer Rudilla M, Canalda Campás M, García Muñoz S, Vicente Gutiérrez L, Jiménez Añón L, Pérez Martínez A, Pons Castillo A, González Tamayo R, Férriz Vivancos J, Rodríguez-Fraga O, Ferrer Díaz de Brito Fernández V, Aguadero V, García Arévalo MG, Arnaldos Carrillo M, González Morales M, Núñez Gárate M, Ruiz Iruela C, Sancho-Rodríguez N, Vila Pérez M, Egea-Caparrós JM, Sáenz L, Blasco Barbero Á, Galán Ortega A. Characteristics and laboratory findings on admission to the emergency department among 2873 hospitalized patients with COVID-19: the impact of adjusted laboratory tests in multicenter studies. A multicenter study in Spain (BIOCOVID-Spain study). Scand J Clin Lab Invest 2021; 81:187-193. [PMID: 33591234 PMCID: PMC7898295 DOI: 10.1080/00365513.2021.1881997] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/31/2020] [Accepted: 01/24/2021] [Indexed: 02/08/2023]
Abstract
Identification of predictors for severe disease progression is key for risk stratification in COVID-19 patients. We aimed to describe the main characteristics and identify the early predictors for severe outcomes among hospitalized patients with COVID-19 in Spain. This was an observational, retrospective cohort study (BIOCOVID-Spain study) including COVID-19 patients admitted to 32 Spanish hospitals. Demographics, comorbidities and laboratory tests were collected. Outcome was in-hospital mortality. For analysis, laboratory tests values were previously adjusted to assure the comparability of results among participants. Cox regression was performed to identify predictors. Study population included 2873 hospitalized COVID-19 patients. Nine variables were independent predictors for in-hospital mortality, including creatinine (Hazard ratio [HR]:1.327; 95% Confidence Interval [CI]: 1.040-1.695, p = .023), troponin (HR: 2.150; 95% CI: 1.155-4.001; p = .016), platelet count (HR: 0.994; 95% CI: 0.989-0.998; p = .004) and C-reactive protein (HR: 1.037; 95% CI: 1.006-1.068; p = .019). This is the first multicenter study in which an effort was carried out to adjust the results of laboratory tests measured with different methodologies to guarantee their comparability. We reported a comprehensive information about characteristics in a large cohort of hospitalized COVID-19 patients, focusing on the analytical features. Our findings may help to identify patients early at a higher risk for an adverse outcome.
Collapse
Affiliation(s)
| | - Daniel Morell-García
- Laboratory Medicine Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Josep Miquel Bauça
- Laboratory Medicine Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Clara Esparza del Valle
- Laboratory Medicine Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - José M. Álamo
- Biochemical Laboratory, Hospital Marina Baixa, Villajoyosa, Spain
| | | | | | | | | | - María A. Juncos Tobarra
- Laboratory Medicine Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Juan A. Vílchez
- Laboratory Medicine Department. Hospital, Universitario Morales Meseguer, Murcia, Spain
| | | | | | - Yolanda Pastor Murcia
- Laboratory Medicine Department, Consorci Hospital General Universitari de València, Valencia, Spain
| | | | - Laura Altimira Queral
- Laboratory Medicine Department, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Elisa Nuez-Zaragoza
- Clinical Laboratory Department, Parc Tauli Hospital Universitari, Sabadell, Spain
| | | | - Alicia Ruiz Ripa
- Laboratory Medicine Department, Hospital de Mataró, Mataró, Spain
| | | | - Iria Cebreiros López
- Laboratory Medicine Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - Álex Larruzea
- Laboratory Medicine Deparment, Hospital Fundació Sanitària Mollet, Barcelona, Spain
| | | | | | | | | | - Cristina Acevedo Alcaraz
- Laboratory Medicine Department. Hospital, Universitario Los Arcos del Mar Menor, San Javier, Spain
| | | | | | | | - Marina Vera
- Biochemical Laboratory, Hospital Marina Baixa, Villajoyosa, Spain
| | | | | | - Sara García Muñoz
- Laboratory Medicine Department, Hospital Universitario de Basurto, Bilbao, Spain
| | - Luis Vicente Gutiérrez
- Laboratory Medicine Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Laura Jiménez Añón
- Laboratory Medicine Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Ruth González Tamayo
- Laboratory Medicine Department, Hospital Universitario de Torrevieja, Torrevieja, Spain
| | - Jorge Férriz Vivancos
- Laboratory Medicine Department, Consorci Hospital General Universitari de València, Valencia, Spain
| | | | | | - Vicente Aguadero
- Clinical Laboratory Department, Parc Tauli Hospital Universitari, Sabadell, Spain
| | | | | | | | | | - Cristina Ruiz Iruela
- Laboratory Medicine Deparment, Hospital Fundació Sanitària Mollet, Barcelona, Spain
| | | | - Marti Vila Pérez
- Laboratory Medicine Department, Hospital Verge de la Cinta, Tortosa, Spain
| | - José M. Egea-Caparrós
- Laboratory Medicine Department. Hospital, Universitario Los Arcos del Mar Menor, San Javier, Spain
| | - Luis Sáenz
- Laboratory Medicine Department. Hospital General, Universitario Rafael Méndez, Lorca, Spain
| | | | - Amparo Galán Ortega
- Comisión de Magnitudes Biológicas relacionadas con la Urgencia Médica, Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, Spain
| |
Collapse
|
12
|
García de Guadiana Romualdo L, Rodríguez Rojas C, Ramos Arenas V, Cárdenas Gámez R, López Abellán MD, González Morales M. Increased concentrations of procalcitonin in patients with paracetamol intoxication. ADVANCES IN LABORATORY MEDICINE 2021; 2:287-295. [PMID: 37363327 PMCID: PMC10197320 DOI: 10.1515/almed-2020-0108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/01/2020] [Indexed: 06/28/2023]
Abstract
Objectives Paracetamol intoxication is one of the causes of elevated procalcitonin concentrations unrelated to infection. We report a case series of two patients intoxicated with paracetamol whose laboratory data revealed a significant elevation of serum procalcitonin concentrations without clinical, radiological and/or biological evidence of infection. The underlying mechanism by which paracetamol triggers an increase in procalcitonin concentrations is still unclear. Case presentation We report two cases of paracetamol intoxication. Both patients were admitted to the Emergency Department (ED) and subsequently transferred to the Intensive Care Unit (ICU). The patients exhibited elevated procalcitonin levels during the first hours of admission without clinical and/or microbiological evidence of infection that could explain such increase. Notably, only Case 1 developed liver injury, with alterations in alanine aminotransferase (ALT), aspartate aminotransferase (AST), bilirubin and esterified bilirubin concentrations, which were not observed in Case 2. Conclusions The two patients showed elevated procalcitonin concentrations resulting from paracetamol intoxication, although only a patient exhibited signs of liver injury. These findings suggest that increased procalcitonin levels induced by a paracetamol overdose cannot be fully explained by hepatocyte injury alone, but other mechanisms involving other organs and tissues may also be associated. In any case, although this mechanism is not well understood, it is important to be aware of this limitation when using procalcitonin as a biomarker of infection in patients intoxicated with paracetamol.
Collapse
Affiliation(s)
| | | | | | - Rubén Cárdenas Gámez
- Laboratory Medicine Department, Santa Lucía University Hospital, Cartagena, Spain
| | | | | |
Collapse
|
13
|
Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, Panagaki A, Melachroinopoulos N, Drakou E, Marousis K, Chrysos G, Spyrou A, Alexiou N, Symbardi S, Alexiou Z, Lagou S, Kolonia V, Gkavogianni T, Kyprianou M, Anagnostopoulos I, Poulakou G, Lada M, Makina A, Roulia E, Koupetori M, Apostolopoulos V, Petrou D, Nitsotolis T, Antoniadou A, Giamarellos-Bourboulis EJ. Procalcitonin to Reduce Long-Term Infection-associated Adverse Events in Sepsis. A Randomized Trial. Am J Respir Crit Care Med 2021; 203:202-210. [PMID: 32757963 PMCID: PMC7874409 DOI: 10.1164/rccm.202004-1201oc] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Rationale: Although early antimicrobial discontinuation guided by procalcitonin (PCT) has shown decreased antibiotic consumption in lower respiratory tract infections, the outcomes in long-term sepsis sequelae remain unclear. Objectives: To investigate if PCT guidance may reduce the incidence of long-term infection-associated adverse events in sepsis. Methods: In this multicenter trial, 266 patients with sepsis (by Sepsis-3 definitions) with lower respiratory tract infections, acute pyelonephritis, or primary bloodstream infection were randomized (1:1) to receive either PCT-guided discontinuation of antimicrobials or standard of care. The discontinuation criterion was ≥80% reduction in PCT levels or any PCT ≤0.5 μg/L at Day 5 or later. The primary outcome was the rate of infection-associated adverse events at Day 180, a composite of the incidence of any new infection by Clostridioides difficile or multidrug-resistant organisms, or any death attributed to baseline C. difficile or multidrug-resistant organism infection. Secondary outcomes included 28-day mortality, length of antibiotic therapy, and cost of hospitalization. Measurements and Main Results: The rate of infection-associated adverse events was 7.2% (95% confidence interval [CI], 3.8–13.1%; 9/125) versus 15.3% (95% CI, 10.1–22.4%; 20/131) (hazard ratio, 0.45; 95% CI, 0.20–0.98; P = 0.045); 28-day mortality 15.2% (95% CI, 10–22.5%; 19/125) versus 28.2% (95% CI, 21.2–36.5%; 37/131) (hazard ratio, 0.51; 95% CI, 0.29–0.89; P = 0.02); and median length of antibiotic therapy 5 (range, 5–7) versus 10 (range, 7–15) days (P < 0.001) in the PCT and standard-of-care arms, respectively. The cost of hospitalization was also reduced in the PCT arm. Conclusions: In sepsis, PCT guidance was effective in reducing infection-associated adverse events, 28-day mortality, and cost of hospitalization. Clinical trial registered with www.clinicaltrials.gov (NCT03333304).
Collapse
Affiliation(s)
| | | | - George Adamis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | | | | | - Elina Drakou
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Konstantinos Marousis
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Georgios Chrysos
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Andronikos Spyrou
- Third Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Nikolaos Alexiou
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Styliani Symbardi
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | | | - Styliani Lagou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece; and
| | - Virginia Kolonia
- Second Department of Internal Medicine, Sismanogleio General Hospital of Athens, Athens, Greece
| | | | | | - Ioannis Anagnostopoulos
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece; and
| | - Garyfallia Poulakou
- Second Department of Internal Medicine, Thriasio General Hospital of Eleusis, Athens, Greece; and
| | - Malvina Lada
- Second Department of Internal Medicine, Sismanogleio General Hospital of Athens, Athens, Greece
| | | | | | - Marina Koupetori
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | | | - Dimitra Petrou
- Second Department of Internal Medicine, Tzaneio General Hospital of Piraeus, Athens, Greece
| | - Thomas Nitsotolis
- First Department of Internal Medicine, G. Gennimatas General Hospital of Athens, Athens, Greece
| | | | | |
Collapse
|
14
|
Impact of restricting procalcitonin measurements in a Swiss tertiary-care hospital on antibiotic use, clinical outcomes, and costs: An interrupted time-series analysis. Infect Control Hosp Epidemiol 2020; 42:890-892. [PMID: 33261687 DOI: 10.1017/ice.2020.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We evaluated the impact of a restriction of procalcitonin measurements on antibiotic use, length of stay, mortality, and cost in a Swiss tertiary-care hospital using interrupted time-series analysis. There was no significant change in level or slope for rates of antibiotic consumption, and costs decreased considerably, by ~54,488 CHF (US$55,714) per month.
Collapse
|
15
|
Heilmann E, Gregoriano C, Wirz Y, Luyt CE, Wolff M, Chastre J, Tubach F, Christ-Crain M, Bouadma L, Annane D, Damas P, Kristoffersen KB, Oliveira CF, Stolz D, Tamm M, de Jong E, Reinhart K, Shehabi Y, Verduri A, Nobre V, Nijsten M, deLange DW, van Oers JAH, Beishuizen A, Girbes ARJ, Mueller B, Schuetz P. Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: a patient-level meta-analysis from randomized controlled trials. Clin Chem Lab Med 2020; 59:441-453. [PMID: 32986609 DOI: 10.1515/cclm-2020-0931] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/31/2020] [Indexed: 12/25/2022]
Abstract
Objectives Patients with impaired kidney function have a significantly slower decrease of procalcitonin (PCT) levels during infection. Our aim was to study PCT-guided antibiotic stewardship and clinical outcomes in patients with impairments of kidney function as assessed by creatinine levels measured upon hospital admission. Methods We pooled and analyzed individual data from 15 randomized controlled trials who were randomly assigned to receive antibiotic therapy based on a PCT-algorithms or based on standard of care. We stratified patients on the initial glomerular filtration rate (GFR, ml/min/1.73 m2) in three groups (GFR >90 [chronic kidney disease; CKD 1], GFR 15-89 [CKD 2-4] and GFR<15 [CKD 5]). The main efficacy and safety endpoints were duration of antibiotic treatment and 30-day mortality. Results Mean duration of antibiotic treatment was significantly shorter in PCT-guided (n=2,492) compared to control patients (n=2,510) (9.5-7.6 days; adjusted difference in days -2.01 [95% CI, -2.45 to -1.58]). CKD 5 patients had overall longer treatment durations, but a 2.5-day reduction in treatment duration was still found in patients receiving in PCT-guided care (11.3 vs. 8.6 days [95% CI -3.59 to -1.40]). There were 397 deaths in 2,492 PCT-group patients (15.9%) compared to 460 deaths in 2,510 control patients (18.3%) (adjusted odds ratio, 0.88 [95% CI 0.78 to 0.98)]. Effects of PCT-guidance on antibiotic treatment duration and mortality were similar in subgroups stratified by infection type and clinical setting (p interaction >0.05). Conclusions This individual patient data meta-analysis confirms that the use of PCT in patients with impaired kidney function, as assessed by admission creatinine levels, is associated with shorter antibiotic courses and lower mortality rates.
Collapse
Affiliation(s)
- Eva Heilmann
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Yannick Wirz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Michel Wolff
- Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean Chastre
- Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Florence Tubach
- Département d'Epidémiologie Biostatistique et Recherche Clinique, AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Mirjam Christ-Crain
- Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
| | - Lila Bouadma
- Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Djillali Annane
- Department of Critical Care, Hyperbaric Medicine and Home Respiratory Unit, Center for Neuromuscular Diseases, Raymond Poincaré Hospital (AP-HP), Garches, France
| | - Pierre Damas
- Department of General Intensive Care, University Hospital of Liege, Domaine universitaire de Liège, Liege, Belgium
| | | | - Carolina F Oliveira
- Department of Internal Medicine, School of Medcine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Daiana Stolz
- Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Michael Tamm
- Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Evelien de Jong
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Clinical Trial Centre Leipzig, University of Leipzig, Leipzig, Germany
| | - Yahya Shehabi
- Critical Care and Peri-operative Medicine, Monash Health, Melbourne, Australia
- School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Alessia Verduri
- Department of Medical and Surgical Sciences,Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Vandack Nobre
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maarten Nijsten
- University Medical Centre, University of Groningen, Groningen, The Netherlands
| | | | | | | | - Armand R J Girbes
- Department of Intensive Care, VU University Medical Center, Amsterdam, The Netherlands
| | - Beat Mueller
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
16
|
Lippi G, Salvagno GL, Gelati M, Pucci M, Lo Cascio C, Demonte D, Faggian D, Plebani M. Two-center comparison of 10 fully-automated commercial procalcitonin (PCT) immunoassays. Clin Chem Lab Med 2020; 58:77-84. [PMID: 31539351 DOI: 10.1515/cclm-2019-0888] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/30/2019] [Indexed: 01/08/2023]
Abstract
Background This two-center study was designed to verify comparability of procalcitonin (PCT) values among 10 different commercial immunoassays. Methods A total number of 176 routine lithium-heparin plasma samples were divided in identical aliquots and simultaneously analyzed with 10 different PCT immunoassays, including Kryptor BRAHMS PCT sensitive, Abbott Architect BRAHMS PCT, Beckman Coulter Access PCT (on Access and DXI), BioMérieux Vidas BRAHMS PCT, Diasorin Liaison BRAHMS PCT, Fujirebio Lumipulse G BRAHMS PCT, Roche BRAHMS PCT (on Cobas E801), Diazyme PCT (on Roche Cobas C702) and SNIBE Maglumi PCT. Results Highly significant correlation was always found across multiple comparisons, with correlation coefficients comprised between 0.918 and 0.997 (all p < 0.001). Bland and Altman plots analysis revealed highly variable bias among immunoassays, ranging between ±0.2% and ±38.6%. Diazyme PCT on Roche Cobas C702 and SNIBE Maglumi PCT displayed the larger overestimation, whilst PCT values were underestimated by Cobas BRAHAMS PCT. The agreement was always >80% (all p < 0.001), but varied largely across multiple comparisons, ranging between 90%-99% at 0.1 μg/L, 81%-99% at 0.25 μg/L, 83%-100% at 0.5 μg/L, 94%-100% at 2.0 μg/L and 90%-99% at 10 μg/L, respectively. The larger disagreement was observed comparing Diazyme PCT and Maglumi PCT with the other methods. Conclusions Although we found acceptable correlation among 10 commercial PCT immunoassays, the limited agreement at clinical decision thresholds remains a major issue, especially at lower end of PCT concentration, thus potentially contributing to jeopardize the clinical value of this biomarker.
Collapse
Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Gian Luca Salvagno
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Matteo Gelati
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Mairi Pucci
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Claudia Lo Cascio
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Davide Demonte
- Section of Clinical Biochemistry, University Hospital of Verona, Verona, Italy
| | - Diego Faggian
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| |
Collapse
|
17
|
Schuetz P. Procalcitonin Is Useful for Evaluating Patients with Ambiguous Presentation and for Early Discontinuation of Antibiotics in Community-acquired Pneumonia. Am J Respir Crit Care Med 2020; 201:744-745. [PMID: 31800293 PMCID: PMC7068823 DOI: 10.1164/rccm.201910-1970le] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
|
18
|
Zhang H, Meng F, Lu S. Risk factors of sepsis following pancreaticoduodenectomy based on inflammation markers and clinical characteristics. ANZ J Surg 2020; 90:1428-1433. [DOI: 10.1111/ans.15791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Haoyun Zhang
- Department of Hepatobiliary Surgery, First Medical Center of Chinese People's Liberation Army (PLA) General HospitalChinese PLA Medical School Beijing China
| | - Fanyu Meng
- Department of Hepatobiliary Surgery, First Medical Center of Chinese People's Liberation Army (PLA) General HospitalChinese PLA Medical School Beijing China
| | - Shichun Lu
- Department of Hepatobiliary Surgery, First Medical Center of Chinese People's Liberation Army (PLA) General HospitalChinese PLA Medical School Beijing China
| |
Collapse
|
19
|
Sartelli M, Pagani L, Iannazzo S, Moro ML, Viale P, Pan A, Ansaloni L, Coccolini F, D’Errico MM, Agreiter I, Amadio Nespola G, Barchiesi F, Benigni V, Binazzi R, Cappanera S, Chiodera A, Cola V, Corsi D, Cortese F, Crapis M, Cristini F, D’Arpino A, De Simone B, Di Bella S, Di Marzo F, Donati A, Elisei D, Fantoni M, Ferrari A, Foghetti D, Francisci D, Gattuso G, Giacometti A, Gesuelli GC, Marmorale C, Martini E, Meledandri M, Murri R, Padrini D, Palmieri D, Pauri P, Rebagliati C, Ricchizzi E, Sambri V, Schimizzi AM, Siquini W, Scoccia L, Scoppettuolo G, Sganga G, Storti N, Tavio M, Toccafondi G, Tumietto F, Viaggi B, Vivarelli M, Tranà C, Raso M, Labricciosa FM, Dhingra S, Catena F. A proposal for a comprehensive approach to infections across the surgical pathway. World J Emerg Surg 2020; 15:13. [PMID: 32070390 PMCID: PMC7029591 DOI: 10.1186/s13017-020-00295-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/10/2020] [Indexed: 02/08/2023] Open
Abstract
Despite evidence supporting the effectiveness of best practices in infection prevention and management, many healthcare workers fail to implement them and evidence-based practices tend to be underused in routine practice. Prevention and management of infections across the surgical pathway should always focus on collaboration among all healthcare workers sharing knowledge of best practices. To clarify key issues in the prevention and management of infections across the surgical pathway, a multidisciplinary task force of experts convened in Ancona, Italy, on May 31, 2019, for a national meeting. This document represents the executive summary of the final statements approved by the expert panel.
Collapse
Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | | | - Maria Luisa Moro
- Regional Agency for Health and Social Care, Emilia-Romagna Region–ASSR, Bologna, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum”-University of Bologna, Bologna, Italy
| | - Angelo Pan
- Infectious Diseases, ASST di Cremona, Cremona, Italy
| | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Federico Coccolini
- Emergency Surgery Unit, New Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Marcello Mario D’Errico
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Iris Agreiter
- Bone Marrow Transplant Unit, Denis Burkitt, St. James’s Hospital, Dublin, Ireland
| | | | - Francesco Barchiesi
- Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Valeria Benigni
- Clinical Administration, Senigallia Hospital, ASUR Marche, Senigallia, AN Italy
| | | | - Stefano Cappanera
- Infectious Diseases Clinic, Department of Medicine, “S. Maria” Hospital, Terni, University of Perugia, Perugia, Italy
| | | | - Valentina Cola
- Department of Hospital Pharmacy, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Daniela Corsi
- Department of Anesthesiology and Intensive Care Unit, Civitanova Marche Hospital, ASUR Marche, Civitanova Marche, MC Italy
| | - Francesco Cortese
- Emergency Surgery and Trauma Care Unit, San Filippo Neri Hospital, Rome, Italy
| | - Massimo Crapis
- Infectious Diseases Unit, Pordenone Hospital, Pordenone, Friuli-Venezia Giulia Italy
| | | | - Alessandro D’Arpino
- Hospital Pharmacy Unit, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy
| | - Belinda De Simone
- Operative Unit of General Surgery, Azienda USL IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Di Bella
- Infectious Diseases Department, Trieste University Hospital, Trieste, Italy
| | | | - Abele Donati
- Department of Anesthesiology and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Daniele Elisei
- Department of Anesthesiology and Intensive Care Unit, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Massimo Fantoni
- Department of Infectious Diseases, Fondazione Policlinico A. Gemelli IRCCS, Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy
| | - Anna Ferrari
- Department of Critical Care Medicine Unit, San Filippo Neri Hospital, Rome, Italy
| | - Domitilla Foghetti
- Department of Surgery, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | | | - Gianni Gattuso
- Infectious Diseases Unit, Carlo Poma Hospital, Mantua, Italy
| | - Andrea Giacometti
- Infectious Diseases Clinic, Department of Biological Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | | | - Cristina Marmorale
- Department of Surgery, Marche Polytechnic University of Marche Region, Ancona, Italy
| | - Enrica Martini
- Hospital Hygiene Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Rita Murri
- Department of Infectious Diseases, Fondazione Policlinico A. Gemelli IRCCS, Istituto di Clinica delle Malattie Infettive, Università Cattolica S. Cuore, Rome, Italy
| | - Daniela Padrini
- Clinical Administration Santa Maria Annunziata Hospital, USL Toscana Centro, Florence, Italy
| | | | - Paola Pauri
- Unit of Microbiology and Virology, Senigallia Hospital, Senigallia, AN Italy
| | | | - Enrico Ricchizzi
- Regional Agency for Health and Social Care, Emilia-Romagna Region–ASSR, Bologna, Italy
| | - Vittorio Sambri
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
- Unit of Microbiology, The Great Romagna Area Hub Laboratory, Pievesestina, Cesena, Italy
| | | | - Walter Siquini
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Loredana Scoccia
- Unit of Hospital Pharmacy, Macerata Hospital, ASUR Marche, Macerata, Italy
| | - Giancarlo Scoppettuolo
- Infectious Diseases Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriele Sganga
- Division of Emergency Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Marcello Tavio
- Infectious Diseases Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giulio Toccafondi
- Clinical Risk Management and Patient Safety Center, Tuscany Region, Florence, Italy
| | - Fabio Tumietto
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum”-University of Bologna, Bologna, Italy
| | - Bruno Viaggi
- Department of Anesthesiology, Neuro Intensive Care Unit, Florence Careggi University Hospital, Florence, Italy
| | - Marco Vivarelli
- Unit of Hepato-Pancreato-Biliary and Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, ASUR Marche, Macerata, Italy
| | | | | | - Sameer Dhingra
- Faculty of Medical Sciences, School of Pharmacy, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Fausto Catena
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| |
Collapse
|
20
|
Tosoni A, Paratore M, Piscitelli P, Addolorato G, De Cosmo S, Mirijello A. The use of procalcitonin for the management of sepsis in Internal Medicine wards: current evidence. Panminerva Med 2019; 62:54-62. [PMID: 31729202 DOI: 10.23736/s0031-0808.19.03809-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Procalcitonin (PCT) is a circulating polypeptide produced in response to bacterial infections. Studies conducted in the Intensive Care Unit (ICU) setting have demonstrated its utility as a biomarker of bacterial infection and sepsis. Thus, PCT is widely used to distinguish between sepsis and SIRS, and to guide antibiotic therapy. At present sepsis represents a frequent diagnosis among patients admitted to internal medicine (IM) departments. Basing on the knowledge derived from ICU studies, the use of PCT has become routine in non-intensive wards, contributing to improve the management of sepsis. However, some differences between the two populations of patients - the IM being older, affected by multiple chronic comorbidities and lacking of invasive monitoring - could limit the generalizability of ICU results. Most of the studies on PCT conducted in the IM setting have focused on chronic obstructive pulmonary disease, pneumonia and sepsis. Although PCT represents one of the best biomarker available in routine clinical practice, there are uncertainties on the optimal cut-offs to be used for starting or discontinuing antibiotic treatment in patients with suspected bacterial infection or sepsis, for predicting outcome and on the role of PCT variations during antibiotic treatment. Moreover, several diseases can produce an elevation of PCT levels, thus producing false positive results. This represents a narrative review summarizing current evidences on PCT for the management of sepsis in an Internal Medicine wards, highlighting differences with ICU, with a special focus on the role of PCT variations as predictor of outcomes in non-ICU wards.
Collapse
Affiliation(s)
- Alberto Tosoni
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, A. Gemelli Hospital, Catholic University of Rome, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS Research Hospital, Rome, Italy
| | - Mattia Paratore
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, A. Gemelli Hospital, Catholic University of Rome, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS Research Hospital, Rome, Italy
| | - Pamela Piscitelli
- Internal Medicine Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Giovanni Addolorato
- Internal Medicine and Alcohol Related Disease Unit, Department of Internal Medicine and Gastroenterology, A. Gemelli Hospital, Catholic University of Rome, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS Research Hospital, Rome, Italy
| | - Salvatore De Cosmo
- Internal Medicine Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Mirijello
- Internal Medicine Unit, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy -
| | | |
Collapse
|
21
|
Schuetz P, Stolz D. Guiding antibiotic treatment with inflammatory biomarkers in COPD? Another brick in the wall. Eur Respir J 2019; 53:53/5/1900562. [DOI: 10.1183/13993003.00562-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 11/05/2022]
|