ça n'a aucun interet en routine aux urgences sauf exception bien sûr
notamment chez vous si le patient reste plusieurs jours dans les urgences
ça n'est pas un examen de routine
trés utilisé en réanimation et infectiologie
sur automate Kryptor en 25 sur serum
Dr.OLIVIER Philippe
Chef de service SAMU-SMUR-Urgences
Président de la C.M.E.
Délégué régional AMUF
Portable 0432753180
secrétariat 3280
Fax 04 32 75 32 85
E-mail: [EMAIL PROTECTED]
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>>> [EMAIL PROTECTED] 16/03/2007 19:15 >>>
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.
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