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

• DOI: 10.2147/copd.s104051
• Publication Date: 2016-06-23T01:21:13Z
• Authors: Caspar Corti; Markus Fally; Andreas Fabricius...; Katrine Mortensen; Birgitte Nybo Jensen; Helle Andreassen; Celeste Porsbjerg; Jenny Dahl Knudsen; Jens-Ulrik Jensen
• Keywords: Calcitonin; Male; Denmark; Point-of-Care Systems; Clinical Decision-Making; International Journal of Chronic Obstructive Pulmonary Disease; Drug Administration Schedule; 03 medical and health sciences; 0302 clinical medicine; Drug Resistance, Bacterial; Journal Article; Humans; Lung; Original Research; Aged; Aged, 80 and over; Patient Selection; Middle Aged; Anti-Bacterial Agents; 3. Good health; Hospitalization; Disease Progression; Female; Guideline Adherence; Algorithms; Biomarkers

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).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).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.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.