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

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
• bacterial infection
• antibiotic stewardship
• procalcitonin
• biomarker-guided
• point-of-care

Acknowledgments

The ProToCOLD study group is most grateful to all the clinicians who recruited patients for the study. Especially, we want to thank nurse Pia Andersen, who coordinated PCT measurement and patient flow at the Department of Respiratory Medicine at Copenhagen University Hospital Bispebjerg. This work was supported by bioMérieux Denmark ApS, which provided both the automated immunoassay system (mini VIDAS^®) and the assays used for POC PCT measurement during the study period. Thermo Fisher Scientific, MA, USA supported the running costs of the study with €2,000. BioMérieux and Thermo Fisher were neither involved in the study design, in the collection, analysis, and interpretation of data, and in the writing of the report nor in the decision to submit the article for publication.

Disclosure

Caspar Corti received an unrestricted grant of €2,000 by Thermo Fisher Scientific, MA, USA, and bioMérieux Denmark Aps supported the study non-financially. The authors report no other conflicts of interest in this work.