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Procalcitonin-guided therapy for the initiation of antibiotics in the ED: a systematic review.
van der Does, Yuri; Rood, Pleunie P M; Haagsma, Juanita A; Patka, Peter; van Gorp, Eric C M; Limper, Maarten.
Afiliação
  • van der Does Y; Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: y.vanderdoes@erasmusmc.nl.
  • Rood PP; Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: p.rood@erasmusmc.nl.
  • Haagsma JA; Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: j.haagsma@erasmusmc.nl.
  • Patka P; Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: p.patka@erasmusmc.nl.
  • van Gorp EC; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: e.vangorp@erasmusmc.nl.
  • Limper M; Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: m.limper@erasmusmc.nl.
Am J Emerg Med ; 34(7): 1286-93, 2016 Jul.
Article em En | MEDLINE | ID: mdl-27130585
ABSTRACT

BACKGROUND:

Procalcitonin (PCT) is a new biomarker with a higher accuracy in the diagnosis of bacterial infections. Utilization of PCT may reduce the number of unnecessary antibiotics prescribed to patients and consequently may decrease the rise in antibiotic resistance. The aim of this systematic review is to determine if a PCT-guided algorithm can safely reduce the number of antibiotics prescribed to all patients with a suspected of infection in the emergency department (ED).

METHODS:

MEDLINE, EMBASE, Web of Science, COCHRANE central, PubMed publisher, and Google scholar were searched. Two reviewers performed the screening independently. The QUADAS 2 tool was used to assess quality.

RESULTS:

In total, 1621 articles were screened. Nine articles were included in the analysis. In the 6 studies on adult patients, only patients with respiratory tract infections were investigated. In these studies, a cutoff value of 0.25 µg/L was used, and PCT-guided therapy reduced the number of prescribed antibiotics significantly. Three studies were on pediatric patients, 2 on fever without source and 1 on respiratory complaints. Procalcitonin-guided therapy did not reduce antibiotic prescription in children. Procalcitonin-guided therapy did not result in an increase in adverse events in any of the studies.

DISCUSSION:

Procalcitonin-guided therapy in the ED is only studied in subpopulations, where it was effective and safe in adult patients with respiratory tract infections and not effective but safe nonetheless in specific pediatric populations. Nonadherence is a significant problem in prospective PCT-guided therapy studies. There is not enough evidence to use PCT-guided therapy in a general ED population.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Bacterianas / Calcitonina / Antibacterianos Tipo de estudo: Prognostic_studies / Qualitative_research / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2016 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Bacterianas / Calcitonina / Antibacterianos Tipo de estudo: Prognostic_studies / Qualitative_research / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2016 Tipo de documento: Article