Procalcitonin testing has the potential to reduce unnecessary antibiotic use in patients with suspected lower respiratory tract infections

摘要

CitationChrist-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, Muller B. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomized, single-blinded intervention trial. Lancet 2004, 363:600–607.BackgroundLower respiratory tract infections are often treated with antibiotics without evidence of clinically relevant bacterial disease. Serum calcitonin precursor concentrations, including procalcitonin, are raised in bacterial infections, but not in viral infections.HypothesisProcalcitonin (PCT)-guided treatment of suspected lower respiratory tract infection substantially reduces antibiotic use without compromising clinical or laboratory outcomes.MethodsDesignProspective, cluster-randomized, controlled, single-blinded intervention trial.SettingMedical emergency department of a 784-bed academic tertiary care hospital in Basel, Switzerland.Subjects243 patients presenting to the emergency department who were admitted with suspected lower respiratory tract infection as the main diagnosis.InterventionPatients were randomly assigned to either standard care (n = 199) or PCT-guided treatment (n = 124). In the latter group, serum PCT concentrations were used to advise clinicians. Use of antibiotics was: strongly discouraged (PCT <0.1 μg/L), discouraged (≥ 0.1 and <0.25 μg/L), advised (≥ 0.25 and <0.5 μg/L), or strongly advised (≥ 0.5 μg/L). Re-evaluation was possible after 6–24 hours in both groups.OutcomesThe primary endpoint was antibiotic use with analysis by intent to treat. Secondary endpoints included clinical and laboratory outcomes.