Picart J, Moiton M P, Gaüzère B-A, Gazaille V, Combes X, DiBernardo S
CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service des urgences, SMUR et SAMU 974, 97400 Saint-Denis, Reunion.
CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service de maladies infectieuses, 97400 Saint-Denis, Reunion.
Med Mal Infect. 2016 Dec;46(8):429-435. doi: 10.1016/j.medmal.2016.07.008. Epub 2016 Sep 5.
Prescribing antibiotics for COPD exacerbations is not easy. Procalcitonin (PCT) is a useful biomarker that helps reduce the rate of antibiotic therapies. However, its proper cut-off levels are often unknown. We aimed to assess the impact of a PCT-based algorithm to guide antibiotic therapy prescription in COPD exacerbations.
We conducted an observational, retrospective, and before/after study. We reviewed physician practices regarding PCT test and antibiotic therapy prescription to all patients hospitalized for COPD exacerbation. We then analyzed the rate of antibiotic prescriptions and the number of PCT tests prescribed before and after the introduction of a protocol validated by previous high-power studies. The primary endpoint was the rate of antibiotic prescriptions.
A total of 124 patients before protocol and 121 patients after protocol were included. Antibiotic prescriptions decreased by 41% after protocol introduction (59% vs. 35%, P<0.001), with no increase in morbidity and mortality at Day 30. Compliance with protocol was complete in 60% of cases and partial (no PCT guidance to discontinue antibiotics) in 8% of cases. Both antibiotic duration (8.3 days vs. 8.7 days) and length of hospital stay (8.5 days vs. 8.3 days, P=0.78) did not change.
Hospital physicians are already using PCT-based algorithm to guide antibiotic prescription in COPD exacerbations. Disseminating information on the appropriate PCT cut-off level to use to decide whether or not to initiate antibiotics is effective. Its proper use should be clarified to reduce antibiotic prescriptions to these overexposed patients.
为慢性阻塞性肺疾病（COPD）急性加重期开具抗生素并非易事。降钙素原（PCT）是一种有用的生物标志物，有助于降低抗生素治疗率。然而，其合适的临界值往往并不明确。我们旨在评估基于PCT的算法对指导COPD急性加重期抗生素治疗处方的影响。
我们进行了一项观察性、回顾性的前后对照研究。我们回顾了所有因COPD急性加重期住院患者的PCT检测及抗生素治疗处方的医生实践情况。然后我们分析了在引入一项经先前高功率研究验证的方案前后抗生素处方率及PCT检测的开具数量。主要终点是抗生素处方率。
方案实施前共纳入124例患者，方案实施后纳入121例患者。方案引入后抗生素处方减少了41%（59%对35%，P<0.001），30天时发病率和死亡率未增加。60%的病例完全符合方案，8%的病例部分符合（无PCT指导停用抗生素）。抗生素使用时长（8.3天对8.7天）及住院时长（8.5天对8.3天，P = 0.78）均未改变。
医院医生已在使用基于PCT的算法来指导COPD急性加重期的抗生素处方。传播关于用于决定是否启动抗生素的合适PCT临界值的信息是有效的。应明确其正确用法，以减少对这些过度暴露患者的抗生素处方。
