Serum Procalcitonin Measurement and Viral Testing to Guide Antibiotic Use for Respiratory Infections in Hospitalized Adults: A Randomized Controlled Trial

Viral lower respiratory tract illness (LRTI) frequently causes adult hospitalization and is linked to antibiotic overuse. European studies suggest that the serum procalcitonin (PCT) level may be used to guide antibiotic therapy. We conducted a trial assessing the feasibility of using PCT algorithms...

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Published in:	The Journal of infectious diseases Vol. 212; no. 11; p. 1692
Main Authors:	Branche, Angela R, Walsh, Edward E, Vargas, Roberto, Hulbert, Barbara, Formica, Maria A, Baran, Andrea, Peterson, Derick R, Falsey, Ann R
Format:	Journal Article
Language:	English
Published:	United States 01.12.2015
Subjects:	Aged Anti-Bacterial Agents - therapeutic use Biomarkers - blood Calcitonin - blood Calcitonin Gene-Related Peptide Female Hospitalization Humans Male Middle Aged New York Prescription Drug Overuse - prevention & control Prescription Drug Overuse - statistics & numerical data Protein Precursors - blood Respiratory Tract Infections - blood Respiratory Tract Infections - drug therapy Respiratory Tract Infections - epidemiology Respiratory Tract Infections - virology Virus Diseases - blood Virus Diseases - drug therapy antibiotic use procalcitonin viral testing respiratory infections
ISSN:	1537-6613, 1537-6613
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Abstract	Viral lower respiratory tract illness (LRTI) frequently causes adult hospitalization and is linked to antibiotic overuse. European studies suggest that the serum procalcitonin (PCT) level may be used to guide antibiotic therapy. We conducted a trial assessing the feasibility of using PCT algorithms with viral testing to guide antibiotic use in a US hospital. Three hundred patients hospitalized with nonpneumonic LRTI during October 2013-April 2014 were randomly assigned at a ratio of 1:1 to receive standard care or PCT-guided care and viral PCR testing. The primary outcome was antibiotic exposure, and safety was assessed at 1 and 3 months. Among the 151 patients in the intervention group, viruses were identified in 42% (63), and 83% (126) had PCT values of <0.25 µg/mL. There were no significant differences in antibiotic use or adverse events between intervention patients and those in the nonintervention group. Subgroup analyses revealed fewer subjects with positive results of viral testing and low PCT values who were discharged receiving antibiotics (20% vs 45%; P = .002) and shorter antibiotic durations among algorithm-adherent intervention patients versus nonintervention patients (2.0 vs 4.0 days; P = .004). Compared with historical controls (from 2008-2011), antibiotic duration in nonintervention patients decreased by 2 days (6.0 vs 4.0 days; P < .001), suggesting a study effect. Although antibiotic use was similar in the 2 arms, subgroup analyses of intervention patients suggest that physicians responded to viral and biomarker data. These data can inform the design of future US studies. NCT01907659.
AbstractList	Viral lower respiratory tract illness (LRTI) frequently causes adult hospitalization and is linked to antibiotic overuse. European studies suggest that the serum procalcitonin (PCT) level may be used to guide antibiotic therapy. We conducted a trial assessing the feasibility of using PCT algorithms with viral testing to guide antibiotic use in a US hospital.BACKGROUNDViral lower respiratory tract illness (LRTI) frequently causes adult hospitalization and is linked to antibiotic overuse. European studies suggest that the serum procalcitonin (PCT) level may be used to guide antibiotic therapy. We conducted a trial assessing the feasibility of using PCT algorithms with viral testing to guide antibiotic use in a US hospital.Three hundred patients hospitalized with nonpneumonic LRTI during October 2013-April 2014 were randomly assigned at a ratio of 1:1 to receive standard care or PCT-guided care and viral PCR testing. The primary outcome was antibiotic exposure, and safety was assessed at 1 and 3 months.METHODSThree hundred patients hospitalized with nonpneumonic LRTI during October 2013-April 2014 were randomly assigned at a ratio of 1:1 to receive standard care or PCT-guided care and viral PCR testing. The primary outcome was antibiotic exposure, and safety was assessed at 1 and 3 months.Among the 151 patients in the intervention group, viruses were identified in 42% (63), and 83% (126) had PCT values of <0.25 µg/mL. There were no significant differences in antibiotic use or adverse events between intervention patients and those in the nonintervention group. Subgroup analyses revealed fewer subjects with positive results of viral testing and low PCT values who were discharged receiving antibiotics (20% vs 45%; P = .002) and shorter antibiotic durations among algorithm-adherent intervention patients versus nonintervention patients (2.0 vs 4.0 days; P = .004). Compared with historical controls (from 2008-2011), antibiotic duration in nonintervention patients decreased by 2 days (6.0 vs 4.0 days; P < .001), suggesting a study effect.RESULTSAmong the 151 patients in the intervention group, viruses were identified in 42% (63), and 83% (126) had PCT values of <0.25 µg/mL. There were no significant differences in antibiotic use or adverse events between intervention patients and those in the nonintervention group. Subgroup analyses revealed fewer subjects with positive results of viral testing and low PCT values who were discharged receiving antibiotics (20% vs 45%; P = .002) and shorter antibiotic durations among algorithm-adherent intervention patients versus nonintervention patients (2.0 vs 4.0 days; P = .004). Compared with historical controls (from 2008-2011), antibiotic duration in nonintervention patients decreased by 2 days (6.0 vs 4.0 days; P < .001), suggesting a study effect.Although antibiotic use was similar in the 2 arms, subgroup analyses of intervention patients suggest that physicians responded to viral and biomarker data. These data can inform the design of future US studies.CONCLUSIONSAlthough antibiotic use was similar in the 2 arms, subgroup analyses of intervention patients suggest that physicians responded to viral and biomarker data. These data can inform the design of future US studies.NCT01907659.CLINICAL TRIALS REGISTRATIONNCT01907659. Viral lower respiratory tract illness (LRTI) frequently causes adult hospitalization and is linked to antibiotic overuse. European studies suggest that the serum procalcitonin (PCT) level may be used to guide antibiotic therapy. We conducted a trial assessing the feasibility of using PCT algorithms with viral testing to guide antibiotic use in a US hospital. Three hundred patients hospitalized with nonpneumonic LRTI during October 2013-April 2014 were randomly assigned at a ratio of 1:1 to receive standard care or PCT-guided care and viral PCR testing. The primary outcome was antibiotic exposure, and safety was assessed at 1 and 3 months. Among the 151 patients in the intervention group, viruses were identified in 42% (63), and 83% (126) had PCT values of <0.25 µg/mL. There were no significant differences in antibiotic use or adverse events between intervention patients and those in the nonintervention group. Subgroup analyses revealed fewer subjects with positive results of viral testing and low PCT values who were discharged receiving antibiotics (20% vs 45%; P = .002) and shorter antibiotic durations among algorithm-adherent intervention patients versus nonintervention patients (2.0 vs 4.0 days; P = .004). Compared with historical controls (from 2008-2011), antibiotic duration in nonintervention patients decreased by 2 days (6.0 vs 4.0 days; P < .001), suggesting a study effect. Although antibiotic use was similar in the 2 arms, subgroup analyses of intervention patients suggest that physicians responded to viral and biomarker data. These data can inform the design of future US studies. NCT01907659.
Author	Hulbert, Barbara Branche, Angela R Baran, Andrea Falsey, Ann R Walsh, Edward E Vargas, Roberto Formica, Maria A Peterson, Derick R
Author_xml	– sequence: 1 givenname: Angela R surname: Branche fullname: Branche, Angela R organization: Department of Medicine, University of Rochester – sequence: 2 givenname: Edward E surname: Walsh fullname: Walsh, Edward E organization: Department of Medicine, University of Rochester Department of Medicine, Rochester General Hospital, New York – sequence: 3 givenname: Roberto surname: Vargas fullname: Vargas, Roberto organization: Department of Laboratory Sciences, Rochester General Hospital, New York – sequence: 4 givenname: Barbara surname: Hulbert fullname: Hulbert, Barbara organization: Department of Laboratory Sciences, Rochester General Hospital, New York – sequence: 5 givenname: Maria A surname: Formica fullname: Formica, Maria A organization: Department of Medicine, Rochester General Hospital, New York – sequence: 6 givenname: Andrea surname: Baran fullname: Baran, Andrea organization: Department of Biostatistics and Computational Biology, University of Rochester – sequence: 7 givenname: Derick R surname: Peterson fullname: Peterson, Derick R organization: Department of Biostatistics and Computational Biology, University of Rochester – sequence: 8 givenname: Ann R surname: Falsey fullname: Falsey, Ann R organization: Department of Medicine, University of Rochester Department of Medicine, Rochester General Hospital, New York
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Snippet	Viral lower respiratory tract illness (LRTI) frequently causes adult hospitalization and is linked to antibiotic overuse. European studies suggest that the...
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SubjectTerms	Aged Anti-Bacterial Agents - therapeutic use Biomarkers - blood Calcitonin - blood Calcitonin Gene-Related Peptide Female Hospitalization Humans Male Middle Aged New York Prescription Drug Overuse - prevention & control Prescription Drug Overuse - statistics & numerical data Protein Precursors - blood Respiratory Tract Infections - blood Respiratory Tract Infections - drug therapy Respiratory Tract Infections - epidemiology Respiratory Tract Infections - virology Virus Diseases - blood Virus Diseases - drug therapy
Title	Serum Procalcitonin Measurement and Viral Testing to Guide Antibiotic Use for Respiratory Infections in Hospitalized Adults: A Randomized Controlled Trial
URI	https://www.ncbi.nlm.nih.gov/pubmed/25910632 https://www.proquest.com/docview/1731785990
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