MD Conference Express ICAAC 2011 - (Page 8)

n C L I N I C A L T R I A L H I G H L I G H T S Procalcitonin-Guided Antibiotic Therapy In Patients with Lower Respiratory Tract Infections Written by Eric Butterman To date, evidence regarding the effectiveness of procalcitonin (PCT)-guided antibiotic therapy has been obtained in randomized, controlled trials (RTCs), which may not be representative of routine clinical settings. Werner Albrich, MD, University of Basel, Kantonsspital Aarau, Aarau, Switzerland, presented data from a quality control survey [ISRCTN40854211] that monitored PCT-guided antibiotic therapy and algorithm adherence in simulated “real-life” conditions. The PCT algorithm effectively reduced antibiotic exposure without increasing complications. Regional and cultural differences did not affect outcomes. The integration of the PCT algorithm into daily practice requires ongoing reinforcement and involves a learning process by prescribing physicians [Schuetz P et al. Eur J Clin Microbiol Infect Dis 2010]. This was an observational, prospective, multicenter, international survey of consecutive patients with community-acquired lower respiratory tract infections (LRTIs) in emergency departments or physicians’ offices in Switzerland (n=10), France (n=3), and the United States (n=1) from September 2009 to February 2011. PCT was measured using a rapid, sensitive immunoassay with a functional assay sensitivity of 0.06–0.09 ug/L (KRYPTOR®, Brahms or (Mini-)Vidas®, BioMérieux). Diagnostic workup, antibiotic choice(s), and management were at the physician’s discretion. The algorithm was based on the level of circulating PCT, which correlates with the likelihood for a bacterial infection, and was as follows: • • • • <0.1 µg/L - antibiotic therapy strongly discouraged 0.1 to 0.25 µg/L - antibiotic therapy discouraged 0.26 to 0.5 µg/L- antibiotic therapy recommended >0.5 µg/L - antibiotic therapy strongly recommended The primary endpoint was duration of antibiotic treatment within 30 days (effectiveness). Compliance with the PCT algorithm, adverse medical outcomes (safety), and influence of PCT on antibiotic decision were secondary endpoints. A total of 1810 patients were enrolled (1520 with LRTI and 1425 with 30-day follow-up information). The majority presented with community-acquired pneumonia, followed by acute exacerbations of chronic obstructive pulmonary disease (COPD) and bronchitis. Peer-Reviewed Highlights from the There was good overall algorithm compliance (68.2%), which was affected by treatment site, country, experience, and diagnosis. Good compliance led to significantly shorter antibiotic duration (-43% or 3.8 fewer antibiotic days; HR, 1.27; 95% CI, 1.13 to 1.43; p<0.0001) but did not increase the risk of complications (adj. OR, 1.40; 95% CI, 0.78 to 2.52; p=0.26; Table 1). Table 1. Compliance Does Not Increase Risk for Complications. Compliant* In-hospital complications 30-day mortality Recurrences Antibiotic side effects 20.5% 7.7% 6.4% 3.8% Noncompliant* 16.6% 6.0% 7.6% 6.0% p value 0.07 0.23 0.20 0.05 51st ICAAC *only patients with low PCT value could be in the noncompliant group Antibiotic duration in the ProReal study was shorter than that seen for standard care but longer than that seen in the PCT intervention group of the ProHosp RCT (Table 2) [Schuetz P et al. JAMA 2010]. 8 November 2011 www.mdconferencexpress.com http://www.mdconferencexpress.com http://www.icaac.org/ http://www.mdconferencexpress.com

Table of Contents for the Digital Edition of MD Conference Express ICAAC 2011

MD Conference Express ICAAC 2011
Contents
Infectious Disease Genomics
Emerging Resistance Among Gram-Negative Pathogens
Procalcitonin-Guided Antibiotic Therapy In Patients with Lower Respiratory Tract Infections
Combination Therapy with Flucytosine Improves Survival in AIDS-Related Cryptococcal Meningitis
CXA-201 Effective Against Common ICU Pathogens
Tigecycline Plus Standard Therapy Is More Effective For Treating Infections in Febrile Neutropenic Cancer Patients
Interventions Aimed at Reducing MRSA BSIs Led to Decreased Rates of Nosocomial MSSA BSIs
Is the Effectiveness of aP Vaccine in Pre-Adolescents Insufficient?
TMC435 Effective in the Treatment of HCV Genotype 1 Infection
HIV
Vaccines
Antibiotic Resistance
Drug Discovery
The Conundrum of MDR TB and Combination Therapy
New Drugs to Treat MDR Pathogens
Immunizations in Reproductive Health
Why Can’t Microbes Just Get Along?
The Role of Adjunctive Steroids in the Treatment of Bacterial Meningitis
Human and Animal Viruses Share “One World” and Emerging Zoonotic Infections Continue to Threaten

MD Conference Express ICAAC 2011

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