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Chest Infections |

Treatment of Elderly Patients With Community-Acquired Pneumonia With the Guidance of Procalcitonin

Yong Ho Roh, PhD; Byoung Jun Lee, MD
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KVH Medical Center, Seoul, Republic of Korea


Chest. 2013;144(4_MeetingAbstracts):256A. doi:10.1378/chest.1703693
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Abstract

SESSION TITLE: Infections in Older Patients

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 04:15 PM - 05:15 PM

PURPOSE: Procalcitonin, the precusor peptide of calcitonin, is released in response to a body’s exposure to bacterial antigens or toxins. Serum levels of procalcitonin increase rapidly and its dynamics have prognostic implications in the presence of low respiratory infection. This study aims to assess the initiation and the duration of antibiotic treatment and the clinical outcome with the guidance of procalcitonin level for elderly patients with community-acquired pneumonia

METHODS: A total of 164 elderly patients( more than 70 of age) requiring hospitalization with community-acquired pneumonia were randomized to procalcitonin-guided or usual practice-guided antibiotic treatment. The primary outcome was the initiation and the duration of antibiotic treatment. The secondary outcome was the clinical outcome and the length of hospitalization. In the procalcitonin group(n=80), antibiotics were initiated and discontinued on the basis of cutoff level(<0.25 ug/ L). The control group(n=84) received antibiotics according to the usual practice guideline. Data were analyzed at baseline, day 5, 7, 10, 14 and 4w, 6w with antibiotic treatment, the clinical outcome and the length of hospitalization

RESULTS: At baseline, both groups were similar regarding clinical characteristics. In the procalcitonin group, antibiotic prescriptions on admission(91.3 vs 98.8%, p<0.05) and the duration of antibiotic treatment (11.2 vs 14.6 p< 0.05) were reduced compared with the control group. There was no difference between two groups with respect to overall success rate of treatment( 81.3 vs 83.8% p>0.05), 6 month mortality (13.8 vs 12.5%) and the length of hospitalization ( 14.6 vs 16d)

CONCLUSIONS: Procalcitonin guidance for elderly community-acquired pneumonia offers a sustained advantage over usual practice guideline therapy in reducing antibiotics prescriptions and the duration of antibiotic treatment. And similar result of treatment outcome were shown compared with patients treated with usual practice guideline

CLINICAL IMPLICATIONS: For the treatment of elderly community-acquired pneumonia, procalcitonin is a useful biomarker to reduce inappropriate initiation of antibiotics and the unnecessary prolongation of antibiotics

DISCLOSURE: The following authors have nothing to disclose: Yong Ho Roh, Byoung Jun Lee

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