Procalcitonin to reduce exposure to antibiotics and individualise treatment in hospitalised old patients with pneumonia: a randomised study

BMC Geriatrics

Research

Sabine Drevet¹  Gaëtan Gavazzi²  Virginie Vitrat³  Matthieu Debray³  Thomas Celarier⁴  Fatah Tidadini⁵  Jean Luc Bosson⁶  Marc Paccalin⁷  Marc Bonnefoy⁸  Benoit de Wazieres⁹ 

[1] CHU Grenoble Alpes, B - Hôpital Nord, Av. des Maquis du Grésivaudan Service Universitaire de Gériatrie Clinique, La Tronche, 38700, Grenoble, France;T -Raig, TIMC-IMAG, UMR 5525 Université Grenoble Alpes, Grenoble, France;CHU Grenoble Alpes, B - Hôpital Nord, Av. des Maquis du Grésivaudan Service Universitaire de Gériatrie Clinique, La Tronche, 38700, Grenoble, France;T -Raig, TIMC-IMAG, UMR 5525 Université Grenoble Alpes, Grenoble, France;Gérontopole AURA, Saint-Etienne, France;Centre Hospitalier Annecy Genevois, Pringy Metz-Tessy, France;Chaire Santé des Ainés-Université Jean Monnet, Saint-Etienne, France;Service de Gérontologie Clinique, CHU de Saint-Etienne, Saint-Etienne, France;Département de chirurgie générale et digestive, CHU Grenoble Alpes, Grenoble, France;MESP TIMC-IMAG UMR 5525, Université Grenoble Alpes/CNRS, Grenoble INP, Grenoble, France;Pôle de Santé Publique, CHU Grenoble Alpes, Grenoble, France;Pôle de Gériatrie, CHU de Poitiers, Poitiers, France;Service de médecine gériatrique, CHU Lyon, Groupement hospitalier Sud, Pierre-Bénite, France;Inserm 1060-CarMeN, Oullins, France;Service de médecine interne et gériatrique, CHU de Nîmes, Nîmes, France;

关键词: Aged;    Antibiotic duration;    Bacterial infection biomarkers;    Pneumonia;    Procalcitonin;   

DOI  :  10.1186/s12877-022-03658-4

 received in 2022-08-09, accepted in 2022-11-28,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundTreating pneumonia in old patients remains challenging for clinicians. Moreover, bacterial antimicrobial resistance is a major public health threat.ObjectiveThe 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.MethodsPROPAGE 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.Results107 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).ConclusionAlthough, 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 registrationNCT02173613. This study was first registered on 25/06/2014.

【 授权许可】

CC BY   
© The Author(s) 2022

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