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Procalcitonin (PCT)-guided antibiotic stewardship: An international experts consensus on optimized clinical use

Procalcitonin (PCT)-guided antibiotic stewardship: An international experts consensus on optimized clinical use
Procalcitonin (PCT)-guided antibiotic stewardship: An international experts consensus on optimized clinical use

Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the fixed cut-offs to only one for mild to moderate and one for severe disease (0.25 μg/L and 0.5 μg/L, respectively). Further, guidance on interpretation of PCT results to initiate, withhold or discontinue ABx treatment was included. A combination of clinical patient assessment with PCT levels in well-defined ABS algorithms, in context with continuous education and regular feedback to all ABS stakeholders, has the potential to improve the diagnostic and therapeutic management of patients suspected of bacterial infection, thereby improving ABS effectiveness.

ABx stewardship, bacterial infection, biomarker, procalcitonin, respiratory tract infections, sepsis
1434-6621
Schuetz, Philipp
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Beishuizen, Albertus
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Broyles, Michael
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Ferrer, Ricard
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Gavazzi, Gaetan
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Gluck, Eric Howard
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González Del Castillo, Juan
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Jensen, Jens Ulrik
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Kanizsai, Peter Laszlo
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Kwa, Andrea Lay Hoon
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Krueger, Stefan
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Luyt, Charles Edouard
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Oppert, Michael
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Plebani, Mario
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Shlyapnikov, Sergey A.
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Toccafondi, Giulio
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Townsend, Jennifer
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Welte, Tobias
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Saeed, Kordo
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Schuetz, Philipp
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Beishuizen, Albertus
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Broyles, Michael
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Ferrer, Ricard
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Gavazzi, Gaetan
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Gluck, Eric Howard
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González Del Castillo, Juan
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Jensen, Jens Ulrik
10252f2a-a577-49dd-a8cd-385070455a29
Kanizsai, Peter Laszlo
67aa0450-caf7-4ecf-a7fb-794094df4837
Kwa, Andrea Lay Hoon
bdc00781-1134-4972-b071-83b48e0c0b64
Krueger, Stefan
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Luyt, Charles Edouard
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Oppert, Michael
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Plebani, Mario
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Shlyapnikov, Sergey A.
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Toccafondi, Giulio
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Townsend, Jennifer
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Welte, Tobias
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Saeed, Kordo
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Schuetz, Philipp, Beishuizen, Albertus, Broyles, Michael, Ferrer, Ricard, Gavazzi, Gaetan, Gluck, Eric Howard, González Del Castillo, Juan, Jensen, Jens Ulrik, Kanizsai, Peter Laszlo, Kwa, Andrea Lay Hoon, Krueger, Stefan, Luyt, Charles Edouard, Oppert, Michael, Plebani, Mario, Shlyapnikov, Sergey A., Toccafondi, Giulio, Townsend, Jennifer, Welte, Tobias and Saeed, Kordo (2019) Procalcitonin (PCT)-guided antibiotic stewardship: An international experts consensus on optimized clinical use. Clinical Chemistry and Laboratory Medicine. (doi:10.1515/cclm-2018-1181).

Record type: Review

Abstract

Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the fixed cut-offs to only one for mild to moderate and one for severe disease (0.25 μg/L and 0.5 μg/L, respectively). Further, guidance on interpretation of PCT results to initiate, withhold or discontinue ABx treatment was included. A combination of clinical patient assessment with PCT levels in well-defined ABS algorithms, in context with continuous education and regular feedback to all ABS stakeholders, has the potential to improve the diagnostic and therapeutic management of patients suspected of bacterial infection, thereby improving ABS effectiveness.

Text
[Clinical Chemistry and Laboratory Medicine (CCLM)] Procalcitonin (PCT)-guided antibiotic stewardship an international experts consensus on optimized clinical use - Version of Record
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Accepted/In Press date: 16 December 2018
e-pub ahead of print date: 6 February 2019
Keywords: ABx stewardship, bacterial infection, biomarker, procalcitonin, respiratory tract infections, sepsis

Identifiers

Local EPrints ID: 428669
URI: https://eprints.soton.ac.uk/id/eprint/428669
ISSN: 1434-6621
PURE UUID: 11958bd8-2c76-416e-9244-3d2e55a24fb0

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Date deposited: 06 Mar 2019 17:30
Last modified: 09 Dec 2019 17:41

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Contributors

Author: Philipp Schuetz
Author: Albertus Beishuizen
Author: Michael Broyles
Author: Ricard Ferrer
Author: Gaetan Gavazzi
Author: Eric Howard Gluck
Author: Juan González Del Castillo
Author: Jens Ulrik Jensen
Author: Peter Laszlo Kanizsai
Author: Andrea Lay Hoon Kwa
Author: Stefan Krueger
Author: Charles Edouard Luyt
Author: Michael Oppert
Author: Mario Plebani
Author: Sergey A. Shlyapnikov
Author: Giulio Toccafondi
Author: Jennifer Townsend
Author: Tobias Welte
Author: Kordo Saeed

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