Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia: a randomised study. Gavazzi, G., Drevet, S., Debray, M., Bosson, J. L., Tidadini, F., Paccalin, M., de Wazieres, B., Celarier, T., Bonnefoy, M., & Vitrat, V. BMC geriatrics, 22(1):965, December, 2022. doi abstract bibtex BACKGROUND: Treating pneumonia in old patients remains challenging for clinicians. Moreover, bacterial antimicrobial resistance is a major public health threat. OBJECTIVE: The PROPAGE study evaluated the interest of a strategy using serial measurements of procalcitonin (PCT) to reduce the duration of antibiotic therapy in old patients with pneumonia. METHODS: PROPAGE took place from Dec.-2013 to Jun.-2016 in eight French geriatric units. It was a prospective, comparative, randomised, open-label study involving old patients (≥ 80 years) who had initiated antibiotic treatment for pneumonia in the previous 48 h. PCT was monitored in all patients and two decision-making PCT-based algorithms guided antibiotic therapy in patients from the PCT group. RESULTS: 107 patients were randomised (PCT, n = 50; Control, n = 57). Antibiotic therapy exposure was reduced in the PCT group as compared to the Control group (median duration of antibiotic therapy, 8 vs. 10 days [rank-test, p = 0.001]; antibiotic persistence rates on Days 6 and 8, 54% and 44% vs. 91% and 72%) and no significant difference was found in recovery rate (84% vs. 89.5%; Pearson Chi² test, p = 0.402). CONCLUSION: Although, the superiority of the strategy was not tested using a composite criterion combining antibiotic therapy duration and recovery rate was not tested due to the small sample size, the present study showed that monitoring associated with PCT-guided algorithm could help shorten antibiotic treatment duration in the very old patients without detrimental effects. Measuring PCT levels between Day 4 and Day 6 could be helpful when making the decision regarding antibiotic discontinuation. TRIAL REGISTRATION: NCT02173613. This study was first registered on 25/06/2014.
@article{gavazzi_procalcitonin_2022,
title = {Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia: a randomised study},
volume = {22},
issn = {1471-2318},
shorttitle = {Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia},
doi = {10.1186/s12877-022-03658-4},
abstract = {BACKGROUND: Treating pneumonia in old patients remains challenging for clinicians. Moreover, bacterial antimicrobial resistance is a major public health threat.
OBJECTIVE: The PROPAGE study evaluated the interest of a strategy using serial measurements of procalcitonin (PCT) to reduce the duration of antibiotic therapy in old patients with pneumonia.
METHODS: PROPAGE took place from Dec.-2013 to Jun.-2016 in eight French geriatric units. It was a prospective, comparative, randomised, open-label study involving old patients (≥ 80 years) who had initiated antibiotic treatment for pneumonia in the previous 48 h. PCT was monitored in all patients and two decision-making PCT-based algorithms guided antibiotic therapy in patients from the PCT group.
RESULTS: 107 patients were randomised (PCT, n = 50; Control, n = 57). Antibiotic therapy exposure was reduced in the PCT group as compared to the Control group (median duration of antibiotic therapy, 8 vs. 10 days [rank-test, p = 0.001]; antibiotic persistence rates on Days 6 and 8, 54\% and 44\% vs. 91\% and 72\%) and no significant difference was found in recovery rate (84\% vs. 89.5\%; Pearson Chi² test, p = 0.402).
CONCLUSION: Although, the superiority of the strategy was not tested using a composite criterion combining antibiotic therapy duration and recovery rate was not tested due to the small sample size, the present study showed that monitoring associated with PCT-guided algorithm could help shorten antibiotic treatment duration in the very old patients without detrimental effects. Measuring PCT levels between Day 4 and Day 6 could be helpful when making the decision regarding antibiotic discontinuation.
TRIAL REGISTRATION: NCT02173613. This study was first registered on 25/06/2014.},
language = {eng},
number = {1},
journal = {BMC geriatrics},
author = {Gavazzi, Gaëtan and Drevet, Sabine and Debray, Matthieu and Bosson, Jean Luc and Tidadini, Fatah and Paccalin, Marc and de Wazieres, Benoit and Celarier, Thomas and Bonnefoy, Marc and Vitrat, Virginie},
month = dec,
year = {2022},
pmid = {36517740},
pmcid = {PMC9748380},
keywords = {Aged, Anti-Bacterial Agents, Antibiotic duration, Bacterial Infections, Bacterial infection biomarkers, Biomarkers, Humans, Pneumonia, Procalcitonin, Prospective Studies},
pages = {965},
}
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OBJECTIVE: The PROPAGE study evaluated the interest of a strategy using serial measurements of procalcitonin (PCT) to reduce the duration of antibiotic therapy in old patients with pneumonia. METHODS: PROPAGE took place from Dec.-2013 to Jun.-2016 in eight French geriatric units. It was a prospective, comparative, randomised, open-label study involving old patients (≥ 80 years) who had initiated antibiotic treatment for pneumonia in the previous 48 h. PCT was monitored in all patients and two decision-making PCT-based algorithms guided antibiotic therapy in patients from the PCT group. RESULTS: 107 patients were randomised (PCT, n = 50; Control, n = 57). Antibiotic therapy exposure was reduced in the PCT group as compared to the Control group (median duration of antibiotic therapy, 8 vs. 10 days [rank-test, p = 0.001]; antibiotic persistence rates on Days 6 and 8, 54% and 44% vs. 91% and 72%) and no significant difference was found in recovery rate (84% vs. 89.5%; Pearson Chi² test, p = 0.402). CONCLUSION: Although, the superiority of the strategy was not tested using a composite criterion combining antibiotic therapy duration and recovery rate was not tested due to the small sample size, the present study showed that monitoring associated with PCT-guided algorithm could help shorten antibiotic treatment duration in the very old patients without detrimental effects. Measuring PCT levels between Day 4 and Day 6 could be helpful when making the decision regarding antibiotic discontinuation. TRIAL REGISTRATION: NCT02173613. This study was first registered on 25/06/2014.","language":"eng","number":"1","journal":"BMC geriatrics","author":[{"propositions":[],"lastnames":["Gavazzi"],"firstnames":["Gaëtan"],"suffixes":[]},{"propositions":[],"lastnames":["Drevet"],"firstnames":["Sabine"],"suffixes":[]},{"propositions":[],"lastnames":["Debray"],"firstnames":["Matthieu"],"suffixes":[]},{"propositions":[],"lastnames":["Bosson"],"firstnames":["Jean","Luc"],"suffixes":[]},{"propositions":[],"lastnames":["Tidadini"],"firstnames":["Fatah"],"suffixes":[]},{"propositions":[],"lastnames":["Paccalin"],"firstnames":["Marc"],"suffixes":[]},{"propositions":["de"],"lastnames":["Wazieres"],"firstnames":["Benoit"],"suffixes":[]},{"propositions":[],"lastnames":["Celarier"],"firstnames":["Thomas"],"suffixes":[]},{"propositions":[],"lastnames":["Bonnefoy"],"firstnames":["Marc"],"suffixes":[]},{"propositions":[],"lastnames":["Vitrat"],"firstnames":["Virginie"],"suffixes":[]}],"month":"December","year":"2022","pmid":"36517740","pmcid":"PMC9748380","keywords":"Aged, Anti-Bacterial Agents, Antibiotic duration, Bacterial Infections, Bacterial infection biomarkers, Biomarkers, Humans, Pneumonia, Procalcitonin, Prospective Studies","pages":"965","bibtex":"@article{gavazzi_procalcitonin_2022,\n\ttitle = {Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia: a randomised study},\n\tvolume = {22},\n\tissn = {1471-2318},\n\tshorttitle = {Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia},\n\tdoi = {10.1186/s12877-022-03658-4},\n\tabstract = {BACKGROUND: Treating pneumonia in old patients remains challenging for clinicians. Moreover, bacterial antimicrobial resistance is a major public health threat.\nOBJECTIVE: The PROPAGE study evaluated the interest of a strategy using serial measurements of procalcitonin (PCT) to reduce the duration of antibiotic therapy in old patients with pneumonia.\nMETHODS: PROPAGE took place from Dec.-2013 to Jun.-2016 in eight French geriatric units. It was a prospective, comparative, randomised, open-label study involving old patients (≥ 80 years) who had initiated antibiotic treatment for pneumonia in the previous 48 h. PCT was monitored in all patients and two decision-making PCT-based algorithms guided antibiotic therapy in patients from the PCT group.\nRESULTS: 107 patients were randomised (PCT, n = 50; Control, n = 57). Antibiotic therapy exposure was reduced in the PCT group as compared to the Control group (median duration of antibiotic therapy, 8 vs. 10 days [rank-test, p = 0.001]; antibiotic persistence rates on Days 6 and 8, 54\\% and 44\\% vs. 91\\% and 72\\%) and no significant difference was found in recovery rate (84\\% vs. 89.5\\%; Pearson Chi² test, p = 0.402).\nCONCLUSION: Although, the superiority of the strategy was not tested using a composite criterion combining antibiotic therapy duration and recovery rate was not tested due to the small sample size, the present study showed that monitoring associated with PCT-guided algorithm could help shorten antibiotic treatment duration in the very old patients without detrimental effects. Measuring PCT levels between Day 4 and Day 6 could be helpful when making the decision regarding antibiotic discontinuation.\nTRIAL REGISTRATION: NCT02173613. This study was first registered on 25/06/2014.},\n\tlanguage = {eng},\n\tnumber = {1},\n\tjournal = {BMC geriatrics},\n\tauthor = {Gavazzi, Gaëtan and Drevet, Sabine and Debray, Matthieu and Bosson, Jean Luc and Tidadini, Fatah and Paccalin, Marc and de Wazieres, Benoit and Celarier, Thomas and Bonnefoy, Marc and Vitrat, Virginie},\n\tmonth = dec,\n\tyear = {2022},\n\tpmid = {36517740},\n\tpmcid = {PMC9748380},\n\tkeywords = {Aged, Anti-Bacterial Agents, Antibiotic duration, Bacterial Infections, Bacterial infection biomarkers, Biomarkers, Humans, Pneumonia, Procalcitonin, Prospective Studies},\n\tpages = {965},\n}\n\n","author_short":["Gavazzi, G.","Drevet, S.","Debray, M.","Bosson, J. 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