Details

Autor(en) / Beteiligte

• Montassier, Emmanuel
• Javaudin, François
• Moustafa, Farès
• Nandjou, Demeno
• Maignan, Maxime
• Hardouin, Jean-Benoit
• Annoot, Caroline
• Ogielska, Maja
• Orer, Pascal-Louis
• Schotté, Thibault
• Bouget, Jacques
• Agha Babaei, Syamak
• Raynal, Pierre-Alexis
• Eche, Antoine
• Duc, Albert Trinh
• Cojocaru, Ruxandra-Aimée
• Benaouicha, Nesrine
• Potel, Gilles
• Batard, Eric
• Talan, David A.

Titel

Guideline-Based Clinical Assessment Versus Procalcitonin-Guided Antibiotic Use in Pneumonia: A Pragmatic Randomized Trial

Ist Teil von

• Annals of emergency medicine, 2019-10, Vol.74 (4), p.580-591

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2019

Quelle

MEDLINE

Beschreibungen/Notizen

• Efforts to reduce unnecessary and unnecessarily long antibiotic treatment for community-acquired pneumonia have been attempted through use of procalcitonin and through guidelines based on serial clinical assessment. Our aim is to compare guideline-based clinical assessment– and procalcitonin algorithm–guided antibiotic use among patients with community-acquired pneumonia. We performed a pragmatic, randomized, multicenter trial from November 2012 to April 2015 at 12 French hospitals. We included emergency department (ED) patients older than 18 years with community-acquired pneumonia. Patients were randomly assigned to either the procalcitonin-guided or clinical assessment group. In accordance with past studies, we hypothesized that serial clinical assessment would be superior to procalcitonin-guided care. The primary outcome was antibiotic duration, and secondary outcomes included rates of antibiotic duration less than or equal to 5 days, and clinical success and combined serious adverse outcomes at 30 days in the intention-to-treat population. Of 370 eligible patients, 285 (77%) were randomly assigned to either clinical assessment– (n=143) or procalcitonin-guided care (n=142). Median age was 67 years (range 18 to 93 years) and 40% of patients were deemed to have Pneumonia Severity Index class IV or V. Procalcitonin algorithm adherence was 76%. Antibiotic duration was not significantly different between clinical assessment– and procalcitonin-guided groups (median 9 versus 10 days, respectively). Clinical success rate was 92% in each group and serious adverse outcome rates were similar (15% versus 20%, respectively). Guideline-based serial clinical assessment did not reduce antibiotic exposure compared with procalcitonin-guided care among ED patients with community-acquired pneumonia. The strategies were similar in terms of duration of antibiotic use and clinical outcomes.