Y a-t-il des gens parmis vous qui ont de l'expérience avec l'utilisation de la pro-calcitonine? Est-ce que ça peut être un outils utile selon vous? Les pneumologues de notre hôpital ne connaissent pas ce test. Sylvain Blanchet, md Hôpital Laval _____
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Procalcitonin test can reduce antibiotic use in COPD Clinical Question Can the procalcitonin level be used to safely guide the use of antibiotics in patients with a chronic obstructive pulmonary disease exacerbation? Bottom line Procalcitonin can be used to guide the use of antibiotics in patients with exacerbation of chronic obstructive pulmonary disease (COPD). Antibiotics are optional for those with a procalcitonin level between 0.1 mcg/L and 0.25 mcg/L and are recommended if the procalcitonin level of greater than 0.25 mcg/L. 1b <http://www.cma.ca/index.cfm?la_id=2&ci_id=43421> Reference Stolz D, Christ-Crain M, Bingisser R, et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 2007;131:9-19. Study design: Randomized controlled trial (double-blinded) Funding: Industry Allocation: Uncertain Setting: Emergency department Synopsis Procalcitonin is a biomarker that is elevated in patients with bacterial infection, but not in those with viral infection or other types of inflammation. A previous study (Lancet 2004; 363:600-07) showed that a new, more accurate assay can identify patients with lower respiratory tract infection who are unlkely to benefit from antibiotics. In this study, the researchers identified 226 adults older than 40 years who met standard criteria for an exacerbation of their COPD. All patients had a procalcitonin level drawn. Patients were then randomized into a usual care group or a group that also gave the treating physicians access to the procalcitonin level. A level less than 0.1 mcg/L was reported as absence of bacterial infection with no antibiotic recommended; a level between 0.1 and 0.25 mcg/L was reported as possible bacterial infection with antibiotic use optional; and a level greater than 0.25 mcg/L was interpreted as bacterial infection with antibiotic use recommended. Clinical success or failure was assessed between 2 weeks and 3 weeks after discharge by clinicians blinded to group assignment. Patients were also contacted 6 months after discharge for a clinical assessment. Of the 226 patients initially randomized, 11 in the procalcitonin group and 7 in the standard treatment group were removed from the study because they did not meet criteria for COPD on the basis of inpatient spirometry. Follow-up was excellent up to 6 months for the remainder of patients. Having access to the procalcitonin test result significantly reduced both antibiotic prescriptions during the index hopitalization (40% vs 72%; P < .001) without any difference in the number of days to the next exacerbation (76 days for each group) or the number of exacerbations or hospitalizations in the next 6 months. Interestingly, there was no association between procalcitonin levels and the presence of purulent sputum or abnormal sputum cultures. Only 10 patients developed pneumonia, too small a number to draw any conclusions about the effect of procalcitonin guidance on increasing or decreasing the likelihood of pneumonia. There was no significant difference between groups at any point regarding lung function, symptoms, functional status, or hospital length of stay. Retour aux Archives <javascript:history.back()> POEM Go to InfoRetriever <http://www.cma.ca/index.cfm/ci_id/43330/la_id/2.htm> Copyright © 1995-2007 InfoPOEM, Inc.www.infopoems.com. 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