Procalcitonin for reduced antibiotic exposure in the critical care setting: a systematic review and an economic evaluation.

Abstract:

OBJECTIVE:Procalcitonin may be associated with reduced antibiotic usage compared to usual care. However, individual randomized controlled trials testing this hypothesis were too small to rule out harm, and the full cost-benefit of this strategy has not been evaluated. The purpose of this analysis was to evaluate the effect of a procalcitonin-guided antibiotic strategy on clinical and economic outcomes. INTERVENTIONS:The use of procalcitonin-guided antibiotic therapy. METHODS AND MAIN RESULTS:We searched computerized databases, reference lists of pertinent articles, and personal files. We included randomized controlled trials conducted in the intensive care unit that compared a procalcitonin-guided strategy to usual care and reported on antibiotic utilization and clinically important outcomes. Results were qualitatively and quantitatively summarized. On the basis of no effect in hospital mortality or hospital length of stay, a cost or cost-minimization analysis was conducted using the costs of procalcitonin testing and antibiotic acquisition and administration. Costs were determined from the literature and are reported in 2009 Canadian dollars. Five articles met the inclusion criteria. Procalcitonin-guided strategies were associated with a significant reduction in antibiotic use (weighted mean difference -2.14 days, 95% confidence interval -2.51 to -1.78, p < .00001). No effect was seen of a procalcitonin-guided strategy on hospital mortality (risk ratio 1.06, 95% confidence interval 0.86-1.30, p = .59; risk difference 0.01, 95% confidence interval -0.04 to +0.07, p = .61) and intensive care unit and hospital lengths of stay. The cost model revealed that, for the base case scenario (daily price of procalcitonin Can$49.42, 6 days of procalcitonin measurement, and 2-day difference in antibiotic treatment between procalcitonin-guided therapy and usual care), the point at which the cost of testing equals the cost of antibiotics saved is when daily antibiotics cost Can$148.26 (ranging between Can$59.30 and Can$296.52 on the basis of different assumptions in sensitivity analyses). CONCLUSIONS:Procalcitonin-guided antibiotic therapy is associated with a reduction in antibiotic usage that, under certain assumptions, may reduce overall costs of care. However, the overall estimate cannot rule out a 7% increase in hospital mortality.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Heyland DK,Johnson AP,Reynolds SC,Muscedere J

doi

10.1097/CCM.0b013e31821201a5

subject

Has Abstract

pub_date

2011-07-01 00:00:00

pages

1792-9

issue

7

eissn

0090-3493

issn

1530-0293

journal_volume

39

pub_type

杂志文章,meta分析,评审
  • Computer-assisted learning in critical care: from ENIAC to HAL.

    abstract::Computers are commonly used to serve many functions in today's modern intensive care unit. One of the most intriguing and perhaps most challenging applications of computers has been to attempt to improve medical education. With the introduction of the first computer, medical educators began looking for ways to incorpo...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/00003246-200108001-00006

    authors: Tegtmeyer K,Ibsen L,Goldstein B

    更新日期:2001-08-01 00:00:00

  • Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation.

    abstract:OBJECTIVE:This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. DESIGN:Forty advanced life-support providers leading a cardiac arrest team in a standardi...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3182591fda

    authors: Yeung JH,Ong GJ,Davies RP,Gao F,Perkins GD

    更新日期:2012-09-01 00:00:00

  • During neonatal mechanical ventilatory support, the delivered nitric oxide concentration is affected by the ventilatory setting.

    abstract:OBJECTIVE:To assess whether the delivered nitric oxide (NO) concentration is affected by a change in the ventilatory setting during neonatal mechanical ventilatory support. DESIGN:Prospective, experimental study. SETTING:Laboratory at Nagoya City University Medical School. INTERVENTIONS:This study was performed by u...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200005000-00058

    authors: Yamaguchi N,Togari H,Suzuki S

    更新日期:2000-05-01 00:00:00

  • The Fragility and Reliability of Conclusions of Anesthesia and Critical Care Randomized Trials With Statistically Significant Findings: A Systematic Review.

    abstract:OBJECTIVES:The Fragility Index, which represents the number of patients responsible for a statistically significant finding, has been suggested as an aid for interpreting the robustness of results from clinical trials. A small Fragility Index indicates that the statistical significance of a trial depends on only a few ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000003527

    authors: Grolleau F,Collins GS,Smarandache A,Pirracchio R,Gakuba C,Boutron I,Busse JW,Devereaux PJ,Le Manach Y

    更新日期:2019-03-01 00:00:00

  • Emergency preservation and delayed resuscitation allows normal recovery after exsanguination cardiac arrest in rats: a feasibility trial.

    abstract:OBJECTIVE:Emergency preservation and resuscitation (EPR) comprise a novel approach for resuscitation of exsanguination cardiac arrest victims. EPR uses a cold aortic flush to induce deep hypothermic preservation, followed by resuscitation with cardiopulmonary bypass. Development of a rat EPR model would enable study of...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000253398.61666.0D

    authors: Drabek T,Stezoski J,Garman RH,Wu X,Tisherman SA,Stezoski SW,Fisk JA,Jenkins L,Kochanek PM

    更新日期:2007-02-01 00:00:00

  • An assessment of six different pulmonary artery catheters.

    abstract::The performance of three samples each of six brands of flow-directed pulmonary artery (PA) catheters was evaluated. In vivo studies determined the reproducibility of PA waveforms over a range of controlled heart rates when compared to those obtained from a transducer-tipped catheter. In vitro studies determined their ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198703000-00015

    authors: Rutten AJ,Nancarrow C,Ilsley AH,Runciman WB

    更新日期:1987-03-01 00:00:00

  • Effects of naloxone and morphine on acute hypoxic survival in mice.

    abstract:OBJECTIVE:To investigate a role of the opiate system during acute hypoxic hypoxia, the effects of naloxone and morphine on hypoxic survival rate were investigated in awake adult mice. DESIGN:Prospective, randomized, animal trial. SETTING:University research laboratory. SUBJECTS:Male dd-Y mice (n = 864 in experiment ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199909000-00035

    authors: Endoh H,Taga K,Yamakura T,Sato K,Watanabe I,Fukuda S,Shimoji K

    更新日期:1999-09-01 00:00:00

  • Chlorpromazine treatment for neurogenic pulmonary edema.

    abstract::A patient with neurogenic pulmonary edema was successfully treated with the alpha-blocking agent, chlorpromazine. A pathophysiologic basis for this drug's efficacy is discussed. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198503000-00016

    authors: Wohns RN,Tamas L,Pierce KR,Howe JF

    更新日期:1985-03-01 00:00:00

  • Ventricular function in myocardial contusion: a preliminary study.

    abstract::During a consecutive 17 month period, 15 trauma patients were diagnosed as having a myocardial contusion on the basis of abnormal ECG in 14 patients, elevated creatinine phosphokinase (CPK) in 13 patients, and elevated CPK-Muscle Brain (CPK-MB) isoenzyme determination in 11 patients. Using these screening modalities, ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198201000-00005

    authors: Torres-Mirabal P,Gruenberg JC,Talbert JG,Brown RS

    更新日期:1982-01-01 00:00:00

  • Hyperbaric Oxygen Therapy Alleviates Carbon Monoxide Poisoning-Induced Delayed Memory Impairment by Preserving Brain-Derived Neurotrophic Factor-Dependent Hippocampal Neurogenesis.

    abstract:OBJECTIVE:To test the hypothesis that hyperbaric oxygen therapy ameliorates delayed cognitive impairment after acute carbon monoxide poisoning by promoting neurogenesis through upregulating the brain-derived neurotrophic factor in the hippocampus. DESIGN:Laboratory animal experiments. SETTING:University/Medical cente...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000001299

    authors: Liu WC,Yang SN,Wu CW,Chen LW,Chan JY

    更新日期:2016-01-01 00:00:00

  • Association of hypomagnesemia and mortality in acutely ill medical patients.

    abstract:OBJECTIVE:To test the hypothesis that the mortality rate of acutely ill patients admitted to a medical ward or medical ICU is higher for those patients who present with hypomagnesemia than for those patients who do not present with hypomagnesemia. DESIGN:Prospective, observational study. SETTING:Emergency Department ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199302000-00010

    authors: Rubeiz GJ,Thill-Baharozian M,Hardie D,Carlson RW

    更新日期:1993-02-01 00:00:00

  • Accuracy of intramucosal pH calculated from arterial bicarbonate and the Henderson-Hasselbalch equation: assessment using simulated ischemia.

    abstract:OBJECTIVES:To determine the accuracy of intramucosal pH (pHi) calculated using arterial bicarbonate instead of mucosal capillary bicarbonate in the Henderson-Hasselbalch equation. DESIGN:Simulation of progressive ischemia in mucosal capillary blood. SETTING:University research laboratory. SUBJECTS:Normal human blood...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199911000-00028

    authors: Morgan TJ,Venkatesh B,Endre ZH

    更新日期:1999-11-01 00:00:00

  • Influenza epidemiology--past, present, and future.

    abstract::In April 2009, Mexican, American, and Canadian authorities announced that a novel influenza virus with pandemic potential had been identified in large segments of the population. Within weeks, it became apparent that the world was dealing with the first influenza pandemic in >40 yrs. Despite the unpredictable nature o...

    journal_title:Critical care medicine

    pub_type: 历史文章,杂志文章,评审

    doi:10.1097/CCM.0b013e3181cbaf34

    authors: Lagacé-Wiens PR,Rubinstein E,Gumel A

    更新日期:2010-04-01 00:00:00

  • Targeted Inhibition of Leucine-Rich Repeat and Immunoglobulin Domain-Containing Protein 1 in Transplanted Neural Stem Cells Promotes Neuronal Differentiation and Functional Recovery in Rats Subjected to Spinal Cord Injury.

    abstract:OBJECTIVE:Leucine-rich repeat and immunoglobulin domain-containing protein (LINGO)-1 is expressed in neural stem cells, and its neutralization results in sustained neuronal immaturity. Thus, targeted inhibition of LINGO-1 via RNA interference may enhance transplanted neural stem cell survival and neuronal differentiati...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000001351

    authors: Chen N,Cen JS,Wang J,Qin G,Long L,Wang L,Wei F,Xiang Q,Deng DY,Wan Y

    更新日期:2016-03-01 00:00:00

  • Hemodynamic, renal, and hormonal actions of aprotinin in an ovine model of septic shock.

    abstract:BACKGROUND AND METHODS:Previous studies documented activation of protease enzymes such as the plasma kallikrein-kinin system in endotoxemia and sepsis, both in experimental animals and in patients. We investigated the actions of aprotinin (a protease inhibitor that binds to plasma kallikrein) on systemic hemodynamics a...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199208000-00012

    authors: Cumming AD,Nimmo GR

    更新日期:1992-08-01 00:00:00

  • Impact of adherence to standard operating procedures for pneumonia on outcome of intensive care unit patients.

    abstract:BACKGROUND:Pneumonia accounts for almost half of intensive care unit (ICU) infections and nearly 60% of deaths from nosocomial infections. It increases hospital stay by 7-9 days, crude mortality by 70% and attributable mortality by 30%. OBJECTIVE:Our purpose was to assess the impact of standard operating procedures ad...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181934f1b

    authors: Nachtigall I,Tamarkin A,Tafelski S,Deja M,Halle E,Gastmeier P,Wernecke KD,Bauer T,Kastrup M,Spies C

    更新日期:2009-01-01 00:00:00

  • Inotropic Effects of Experimental Hyperthermia and Hypothermia on Left Ventricular Function in Pigs-Comparison With Dobutamine.

    abstract:OBJECTIVES:The results from the recent Targeted Temperature Management trial raised the question whether cooling or merely the avoidance of fever mediates better neurologic outcome in resuscitated patients. As temperature per se is a major determinant of cardiac function, we characterized the effects of hyperthermia (4...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000001358

    authors: Alogna A,Manninger M,Schwarzl M,Zirngast B,Steendijk P,Verderber J,Zweiker D,Maechler H,Pieske BM,Post H

    更新日期:2016-03-01 00:00:00

  • Critical care medicine use and cost among Medicare beneficiaries 1995-2000: major discrepancies between two United States federal Medicare databases.

    abstract:OBJECTIVE:A comparison of federal Medicare databases to identify critical care medicine (CCM) use, cost discrepancies, and their possible causes. DESIGN:A 6-yr (1995-2000) retrospective analysis of Medicare hospital and CCM use and cost, comparing the Hospital Cost Report Information System (HCRIS) with Medicare Provi...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000257255.57899.5D

    authors: Halpern NA,Pastores SM,Thaler HT,Greenstein RJ

    更新日期:2007-03-01 00:00:00

  • Double-Stranded RNA Interacts With Toll-Like Receptor 3 in Driving the Acute Inflammatory Response Following Lung Contusion.

    abstract:OBJECTIVES:Lung contusion is a major risk factor for the development of acute respiratory distress syndrome. We set to determine the role of toll-like receptor 3 and the binding of double-stranded RNA in the pathogenesis of sterile injury following lung contusion. DESIGN:Toll-like receptor 3 expression was analyzed in...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000001879

    authors: Suresh MV,Thomas B,Machado-Aranda D,Dolgachev VA,Kumar Ramakrishnan S,Talarico N,Cavassani K,Sherman MA,Hemmila MR,Kunkel SL,Walter NG,Hogaboam CM,Raghavendran K

    更新日期:2016-11-01 00:00:00

  • FTY720 (s)-phosphonate preserves sphingosine 1-phosphate receptor 1 expression and exhibits superior barrier protection to FTY720 in acute lung injury.

    abstract:OBJECTIVE:Effective therapies are needed to reverse the increased vascular permeability that characterizes acute inflammatory diseases such as acute lung injury. FTY720 is a pharmaceutical analog of the potent barrier-enhancing phospholipid, sphingosine 1-phosphate. Because both FTY720 and sphingosine 1-phosphate have ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000000097

    authors: Wang L,Sammani S,Moreno-Vinasco L,Letsiou E,Wang T,Camp SM,Bittman R,Garcia JG,Dudek SM

    更新日期:2014-03-01 00:00:00

  • Increased morbidity with increased pulmonary albumin flux in sepsis-related adult respiratory distress syndrome.

    abstract:OBJECTIVE:To determine the feasibility of utilizing a scintigraphic technique to differentiate patients with adult respiratory distress syndrome due to sepsis syndrome from control volunteers and patients with congestive heart failure. Gamma scintigraphy was compared with chest roentgenograms to predict mortality rate ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199201000-00012

    authors: Byrne K,Tatum JL,Henry DA,Hirsch JI,Crossland M,Barnes T,Thompson JA,Young J,Sugerman HJ

    更新日期:1992-01-01 00:00:00

  • Evaluation of the utility of computed tomography in the initial assessment of the critical care patient with chest trauma.

    abstract:OBJECTIVE:To determine the utility of thoracic computed tomography (TCT) in the initial assessment of critically ill patients with chest injuries. DESIGN:Prospective observational study of cohorts. SETTING:Trauma intensive care unit (ICU) of a Spanish Level III hospital (US equivalent Level I). PATIENTS:Three hundre...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200005000-00018

    authors: Guerrero-López F,Vázquez-Mata G,Alcázar-Romero PP,Fernández-Mondéjar E,Aguayo-Hoyos E,Linde-Valverde CM

    更新日期:2000-05-01 00:00:00

  • Effect of acute physiologic derangements on outcome after subarachnoid hemorrhage.

    abstract:OBJECTIVE:To determine the effect that acute physiologic derangements have on outcome after subarachnoid hemorrhage (SAH) and to design a composite score summarizing these abnormalities. DESIGN:Prospective observational study. SETTING:Neuroscience intensive care unit in a tertiary care academic center. PATIENTS:Cons...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000114830.48833.8a

    authors: Claassen J,Vu A,Kreiter KT,Kowalski RG,Du EY,Ostapkovich N,Fitzsimmons BF,Connolly ES,Mayer SA

    更新日期:2004-03-01 00:00:00

  • Nonphysician transport of intubated pediatric patients: a system evaluation.

    abstract:OBJECTIVE:To evaluate the occurrence of complications and patient deteriorations during the air and ground transportation of intubated pediatric patients, performed by a nonphysician-based team under the direction of an intensive care attending physician or fellow. DESIGN:Retrospective chart review. SETTING:A 600-bed...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199207000-00011

    authors: Beyer AJ 3rd,Land G,Zaritsky A

    更新日期:1992-07-01 00:00:00

  • Prediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation II and III prognostic systems in a United Kingdom intensive care unit.

    abstract:OBJECTIVE:To evaluate the ability of two prognostic systems to predict hospital mortality in adult intensive care patients. DESIGN:Prospective cohort study. SETTING:A mixed medical and surgical intensive care unit (ICU) in the United Kingdom. PATIENTS:A total of 1,144 patients consecutively admitted to the study. I...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199701000-00006

    authors: Beck DH,Taylor BL,Millar B,Smith GB

    更新日期:1997-01-01 00:00:00

  • Granulocyte colony-stimulating factor improves survival rate and reduces concentrations of bacteria, endotoxin, tumor necrosis factor, and endothelin-1 in fulminant intra-abdominal sepsis in rats.

    abstract:OBJECTIVE:To study the therapeutic effect of granulocyte colony-stimulating factor (G-CSF) on the mortality rate and host defense pattern in fulminant intra-abdominal sepsis. DESIGN:Prospective, randomized, controlled trial. SETTING:Research laboratory in a university hospital. SUBJECTS:Adult male Wistar rats. INTE...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199605000-00016

    authors: Lundblad R,Nesland JM,Giercksky KE

    更新日期:1996-05-01 00:00:00

  • Distribution of normal saline and 5% albumin infusions in cardiac surgical patients.

    abstract:OBJECTIVE:To determine the relative distribution of fluid within the extracellular fluid volume (ECFV) and the effect on oxygen delivery after infusing either normal saline or 5% albumin in cardiac surgical patients. DESIGN:Prospective, randomized, unblinded, interventional study. SETTING:Cardiac surgical intensive c...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00003246-200112000-00011

    authors: Ernest D,Belzberg AS,Dodek PM

    更新日期:2001-12-01 00:00:00

  • Effect of dopamine on intrapulmonary shunt fraction and oxygen transport in severe sepsis with circulatory and respiratory failure.

    abstract::The hemodynamic response to a dopamine HCl infusion (10 microgram/kg per min) was measured in 25 adult patients with severe sepsis: there were 6 patients with circulatory hyperdynamic states, 9 patients with myocardial failure, and 10 with hypovolemia. Each patient also had acute respiratory failure. Changes of intrap...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-197906000-00004

    authors: Jardin F,Gurdjian F,Desfonds P,Margairaz A

    更新日期:1979-06-01 00:00:00

  • Commentary on the reimbursement paradox.

    abstract::Reimbursement policies are a critical step in the incorporation of new technologies and therapies into the clinical armamentarium. Reimbursement is an umbrella concept describing the process to manage and pay for healthcare services, including benefit coverage, coding, and payment processes. The technologies and servi...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/CCM.0b013e3181aa6288

    authors: Reaven NL,Rosenbloom J

    更新日期:2009-07-01 00:00:00

  • Burden of early-onset candidemia: analysis of culture-positive bloodstream infections from a large U.S. database.

    abstract:OBJECTIVES:: To characterize the epidemiology and burden of early-onset, nonnosocomial candidemia. DESIGN:: Retrospective review of Cardinal Health Outcomes Research Database, which comprises all acute care admissions at participating hospitals. SETTING:: A total of 176 acute care hospitals. PATIENTS:: All patients ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181a0f95d

    authors: Shorr AF,Gupta V,Sun X,Johannes RS,Spalding J,Tabak YP

    更新日期:2009-09-01 00:00:00