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Randomized Controlled Trial
. 2016 Jun 22:11:1381-9.
doi: 10.2147/COPD.S104051. eCollection 2016.

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

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 Jensen  1
Affiliations
Randomized Controlled Trial

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

Caspar Corti et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

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; antibiotic stewardship; bacterial infection; biomarker-guided; point-of-care; procalcitonin.

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Figures

Figure 1
Figure 1
CONSORT diagram showing patient flow. Abbreviations: PCT, procalcitonin; PPP, per-protocol population; ITT, intention-to-treat; CONSORT, Consolidated Standards of Reporting Trials.
Figure 2
Figure 2
PCT-guided antibiotic therapy – algorithm. Abbreviation: PCT, procalcitonin.
Figure 3
Figure 3
Antibiotic exposure in patients receiving antibiotic therapy, intention-to-treat. Note: Red bars indicate primary endpoints of study. Abbreviations: PCT, procalcitonin; d, days.
Figure 4
Figure 4
Antibiotic exposure in patients receiving antibiotic therapy, per-protocol population. Note: Red bars indicate primary endpoints of study. Abbreviations: PCT, procalcitonin; d, days.
See this image and copyright information in PMC

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