title: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen.
authors.forename: Caspar
authors.initials: C
authors.lastname: Corti
authors.affiliation: Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen.
authors.forename: Markus
authors.initials: M
authors.lastname: Fally
authors.affiliation: Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fabricius-Bjerre
authors.affiliation: Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen.
authors.forename: Katrine
authors.initials: K
authors.lastname: Mortensen
authors.affiliation: Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen.
authors.forename: Birgitte Nybo
authors.initials: BN
authors.lastname: Jensen
authors.affiliation: Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen.
authors.forename: Helle F
authors.initials: HF
authors.lastname: Andreassen
authors.affiliation: Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen.
authors.forename: Celeste
authors.initials: C
authors.lastname: Porsbjerg
authors.affiliation: Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors.forename: Jenny Dahl
authors.initials: JD
authors.lastname: Knudsen
authors.affiliation: Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen.
authors.forename: Jens-Ulrik
authors.initials: JU
authors.lastname: Jensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D000066491:Clinical Decision-Making; D003718:Denmark; D018450:Disease Progression; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019095:Point-of-Care Systems; D000067716:Point-of-Care Testing; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002116:Calcitonin
keywords: COPD exacerbation; antibiotic stewardship; bacterial infection; biomarker-guided; point-of-care; procalcitonin