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Point-of-care procalcitonin test to reduce antibiotic exposure in patients hospitalized with acute exacerbation of COPD

Authors Corti C, Fally M, Fabricius-Bjerre A, Mortensen K, Nybo Jensen B, Andreassen H, Porsbjerg C, Dahl Knudsen J, Jensen J

Received 11 January 2016

Accepted for publication 4 February 2016

Published 22 June 2016 Volume 2016:11(1) Pages 1381—1389


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Caspar Corti,1 Markus Fally,1 Andreas Fabricius-Bjerre,1 Katrine Mortensen,1 Birgitte Nybo Jensen,1 Helle F Andreassen,1 Celeste Porsbjerg,1 Jenny Dahl Knudsen,2 Jens-Ulrik Jensen1

1Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, 2Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark

Background: This study was conducted to investigate whether point-of-care (POC) procalcitonin (PCT) measurement can reduce redundant antibiotic treatment in patients hospitalized with acute exacerbation of COPD (AECOPD).
Methods: One-hundred and twenty adult patients admitted with AECOPD were enrolled in this open-label randomized trial. Patients were allocated to either the POC PCT-guided intervention arm (n=62) or the control arm, in which antibiotic therapy followed local guidelines (n=58).
Results: The median duration of antibiotic exposure was 3.5 (interquartile range [IQR] 0–10) days in the PCT-arm vs 8.5 (IQR 1–11) days in the control arm (P=0.0169, Wilcoxon) for the intention-to-treat population. The proportion of patients using antibiotics for ≥5 days within the 28-day follow-up was 41.9% (PCT-arm) vs 67.2% (P=0.006, Fisher’s exact) in the intention-to-treat population. For the per-protocol population, the proportions were 21.1% (PCT-arm) vs 73.9% (P<0.00001, Fisher’s exact). Within 28-day follow-up, one patient died in the PCT-arm and two died in the control arm. A composite harm end point consisting of death, rehospitalization, or intensive care unit admission, all within 28 days, showed no apparent difference.
Conclusion: Our study shows that the implementation of a POC PCT-guided algorithm can be used to substantially reduce antibiotic exposure in patients hospitalized with AECOPD, with no apparent harm.

Keywords: COPD exacerbation, bacterial infection, antibiotic stewardship, procalcitonin, biomarker-guided, point-of-care

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