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Effects of procalcitonin testing on antibiotic use and clinical outcomes in patients with upper respiratory tract infections. An individual patient data meta-analysis

  • Jonas Odermatt , Natalie Friedli , Alexander Kutz , Matthias Briel , Heiner C. Bucher , Mirjam Christ-Crain , Olaf Burkhardt , Tobias Welte , Beat Mueller and Philipp Schuetz EMAIL logo
Published/Copyright: June 29, 2017
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 56 Issue 1

Abstract

Background:

Several trials found procalcitonin (PCT) helpful for guiding antibiotic treatment in patients with lower respiratory tract infections and sepsis. We aimed to perform an individual patient data meta-analysis on the effects of PCT guided antibiotic therapy in upper respiratory tract infections (URTI).

Methods:

A comprehensive search of the literature was conducted using PubMed (MEDLINE) and Cochrane Library to identify relevant studies published until September 2016. We reanalysed individual data of adult URTI patients with a clinical diagnosis of URTI. Data of two trials were used based on PRISMA-IPD guidelines. Safety outcomes were (1) treatment failure defined as death, hospitalization, ARI-specific complications, recurrent or worsening infection at 28 days follow-up; and (2) restricted activity within a 14-day follow-up. Secondary endpoints were initiation of antibiotic therapy, and total days of antibiotic exposure.

Results:

In total, 644 patients with a follow up of 28 days had a final diagnosis of URTI and were thus included in this analysis. There was no difference in treatment failure (33.1% vs. 34.0%, OR 1.0, 95% CI 0.7–1.4; p=0.896) and days with restricted activity between groups (8.0 vs. 8.0 days, regression coefficient 0.2 (95% CI –0.4 to 0.9), p=0.465). However, PCT guided antibiotic therapy resulted in lower antibiotic prescription (17.8% vs. 51.0%, OR 0.2, 95% CI 0.1–0.3; p<0.001) and in a 2.4 day (95% CI –2.9 to –1.9; p<0.001) shorter antibiotic exposure compared to control patients.

Conclusions:

PCT guided antibiotic therapy in the primary care setting was associated with reduced antibiotic exposure in URTI patients without compromising outcomes.

Keywords: lower antibiotic exposure; meta-analysis; primary care setting; procalcitonin; procalcitonin guided antibiotic prescription; upper respiratory tract infection
Corresponding author: Prof. Philipp Schuetz, MD, MPH, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001 Aarau, Switzerland, Phone: +41628389524, Fax: +41628386945

Acknowledgments

We are grateful to the physicians, their staff and patients who participated in the data collection.

  1. Author contributions: Mr Odermatt, Ms Friedli, Mr Kutz and Mr. Schuetz had full access to all of the data in the study and take responsibility for the integrity of the data and performed the statistical work, and drafted the manuscript. All authors helped to interpret the findings, read and revised the manuscript critically for important intellectual content. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Availability of data and material: The datasets used and/or analysed during the current study is available from the corresponding author on reasonable request.

  3. Research funding: This investigator-initiated PARTI trial was sponsored by a grant from the Swiss National Science Foundation (3300C0-107772) and by the Association for the Promotion of Science and Postgraduate Training of the University Hospital Basel. Brahms AG provided assay and kit material related to the study. Drs. Christ-Crain, Mueller, and Schuetz, received support from BRAHMS to attend meetings and fulfilled speaking engagements. Drs. Schuetz, Kutz, Christ-Crain and Mueller received support from bioMérieux to attend meetings and fulfilled speaking engagements. Heiner C. Bucher has received research support from BRAHMS. Dr. Schuetz and Dr. Christ-Crain were supported by funds of the Freiwillige Akademische Gesellschaft, the Department of Endocrinology, Diabetology and Clinical Nutrition, and the Department of Clinical Chemistry, all Basel, Switzerland.

  4. Employment or leadership: Dr. Mueller has served as a consultant and received research support from BRAHMS and bioMérieux.

  5. Honorarium: None declared.

  6. Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Supplemental Material:

The online version of this article (https://doi.org/10.1515/cclm-2017-0252) offers supplementary material, available to authorized users.

Received: 2017-3-23
Accepted: 2017-5-2
Published Online: 2017-6-29
Published in Print: 2017-11-27

©2018 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2017-0252
Keywords for this article
lower antibiotic exposure; meta-analysis; primary care setting; procalcitonin; procalcitonin guided antibiotic prescription; upper respiratory tract infection

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Method comparison – a practical approach based on error identification
  4. Review
  5. Neutrophil gelatinase-associated lipocalin as a risk marker in cardiovascular disease
  6. Mini Reviews
  7. α-Defensin point-of-care test for diagnosis of prosthetic joint infections: neglected role of laboratory and clinical pathologists
  8. The diagnostic accuracy of biomarkers for diagnosis of primary biliary cholangitis (PBC) in anti-mitochondrial antibody (AMA)-negative PBC patients: a review of literature
  9. Opinion Paper
  10. New issues on measurement of B-type natriuretic peptides
  11. Genetics and Molecular Diagnostics
  12. The SEeMORE strategy: single-tube electrophoresis analysis-based genotyping to detect monogenic diseases rapidly and effectively from conception until birth
  13. General Clinical Chemistry and Laboratory Medicine
  14. Determination of serum calcium levels by 42Ca isotope dilution inductively coupled plasma mass spectrometry
  15. The effects of dry ice exposure on plasma pH and coagulation analyses
  16. Placental protein-13 (PP13) in combination with PAPP-A and free leptin index (fLI) in first trimester maternal serum screening for severe and early preeclampsia
  17. Circulating CD89-IgA complex does not predict deterioration of kidney function in Korean patients with IgA nephropathy
  18. Performance analysis of automated evaluation of Crithidia luciliae-based indirect immunofluorescence tests in a routine setting – strengths and weaknesses
  19. Performance of automated digital cell imaging analyzer Sysmex DI-60
  20. Reference Values and Biological Variations
  21. Determination of reference intervals for urinary steroid profiling using a newly validated GC-MS/MS method
  22. Reference intervals and longitudinal changes in copeptin and MR-proADM concentrations during pregnancy
  23. Definition of the upper reference limit of glycated albumin in blood donors from Italy
  24. Reference values of fecal calgranulin C (S100A12) in school aged children and adolescents
  25. Processing-independent proANP measurement for low concentrations in plasma: reference intervals and effect of body mass index and plasma glucose
  26. Cancer Diagnostics
  27. Cancer sniffer dogs: how can we translate this peculiarity in laboratory medicine? Results of a pilot study on gastrointestinal cancers
  28. Cardiovascular Diseases
  29. NGAL and MMP-9/NGAL as biomarkers of plaque vulnerability and targets of statins in patients with carotid atherosclerosis
  30. Analytical evaluation of the new Beckman Coulter Access high sensitivity cardiac troponin I immunoassay
  31. Infectious Diseases
  32. Analytical evaluation of the performances of Diazyme and BRAHMS procalcitonin applied to Roche Cobas in comparison with BRAHMS PCT-sensitive Kryptor
  33. Effects of procalcitonin testing on antibiotic use and clinical outcomes in patients with upper respiratory tract infections. An individual patient data meta-analysis
  34. Acknowledgment
  35. Letters to the Editor
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  37. Reply to: Analytical evaluation of the performances of Diazyme and BRAHMS procalcitonin applied to Roche Cobas in comparison with BRAHMS PCT-sensitive Kryptor
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