title: Impact of procalcitonin-guided therapy for hospitalized community-acquired pneumonia on reducing antibiotic consumption and costs in Japan.
abstract: OBJECTIVE
  This study aimed to investigate the usefulness of procalcitonin-guided therapy in hospitalized community-acquired pneumonia patients to reduce antibiotic duration and costs without worsening prognosis.
  
  
  METHODS
  352 hospitalized community-acquired pneumonia patients in an observational cohort study in which procalcitonin was measured three times serially, on admission (Day 1) and 2-3 days (Day 3) and 6-8 days (Day 7) after admission, between October 2010 and February 2016 were reviewed retrospectively. Antibiotics could be stopped if Day 7 procalcitonin was <0.25 ng mL-1or ≤10% of the higher value of procalcitonin on Day 1 or 3. Antibiotic duration and costs and recurrence and mortality rates were evaluated in mild to moderate or severe pneumonia by theoretical procalcitonin guidance for community-acquired pneumonia treatment.
  
  
  RESULTS
  Using theoretical procalcitonin guidance, antibiotic duration could be reduced from 12.6 to 8.6 days (P < 0.001), while costs could be reduced from 45,833 to 38,952 yen (P = 0.005). Among the patients in whom theoretical procalcitonin guidance could be adopted, recurrence rates (5.6% vs. 8.1%, P = 0.15) and mortality rates (0% vs. 5.1%, P = 0.07) did not worsen between the group having the same antibiotic durations as with theoretical procalcitonin guidance in actual practice (N = 71) and the group having durations more than 2 days longer in actual practice than in theoretical procalcitonin guidance (N = 198). There was no significant difference in pneumonia severity using A-DROP, CURB-65, and PSI between two groups.
  
  
  CONCLUSIONS
  Procalcitonin-guided therapy may be useful in hospitalized community-acquired pneumonia patients to reduce antibiotic duration and costs without worsening the prognosis.
authors.affiliation: Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan. Electronic address: ai12306@kchnet.or.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ito
authors.affiliation: Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ishida
authors.affiliation: Department of Clinical Research Institute, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Tokumasu
authors.affiliation: Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Washio
authors.affiliation: Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Yamazaki
authors.affiliation: Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Minami Kyoto Hospital, Kyoto, Japan.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Tachibana
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002116:Calcitonin / Q000008:administration & dosage*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007564:Japan; D008297:Male; D011014:Pneumonia / Q000188:drug therapy*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002116:Calcitonin
keywords: Antibacterial agents; Community-acquired pneumonia; Cost benefit analysis; Procalcitonin; Prognosis