No registrations found.
ID
Source
Brief title
Health condition
Procalcitonin, emergency department, bacterial infection, antibiotics, antibiotic stewardship
Procalcitonine, spoedeisende hulp afdeling, bacteriele infectie, antibiotica
Sponsors and support
Intervention
Outcome measures
Primary outcome
•Number of febrile patients who are prescribed antibiotics in the ED
•Safety of PCT-guided therapy, defined as 30 days mortality, Intensive Care Unit (ICU) admittance, or a return visit to the ED within 14 days.
• Accuracy of PCT and CRP as area under curve (AUC) compared with diagnosis of bacterial or viral infection by culture, polymerase chain reaction (PCR) and serology
Secondary outcome
•Hospital treatment costs (Costs of PCT testing (treatment group only), antibiotics, and other related medical consumption during admittance).
•Related medical consumption during follow-up. (General practitioner (GP) and additional hospital visits, diagnostics and medication)
•Days absence from work and reduced productivity while at work. (if applicable)
•Costs of hospital stay (hospitalized patients) or ICU stay (critically ill patients).
•Costs of extramural antimicrobial therapy.
Background summary
The implementation of PCT testing could help in achieving early diagnosis and adequate management of febrile patients with infectious diseases in the emergency department.
Study objective
PCT is a biomarker that can detect bacterial infections more specific compared to current biomarkers and will result in more accurate antibiotic therapy. Consequently, in cases with other infections (e.g. viral) it will avoid unnecessary antibiotic therapy. Effective antibiotic use will lead to a reduction of antibiotics resistance and costs.
Primary:
- To investigate efficacy of PCT-guided antibiotic therapy in the ED
- To evaluate the safety of PCT-guided antibiotic therapy in the ED
Secondary:
- To study if PCT-guided therapy is cost-effective
- To investigate the accuracy of PCT as biomarker for bacterial infection
Study design
Inclusion will be two years
Intervention
For the primary objective ‘efficacy’ the study is set up a superiority study, in which the new intervention is compared to the current standard-of-care.
For the primary objective ‘safety’ the study is set up as a noninferiority study to investigate whether the new intervention (PCT-guided therapy) is at least as safe as the established intervention.
Intervention: Patients will be allocated into two groups:
1. A control group (standard-of-care)
2. Intervention group (PCT-guided therapy)
Yuri van der Does
Rotterdam
The Netherlands
010-7040704
y.vanderdoes@erasmusmc.nl
Yuri van der Does
Rotterdam
The Netherlands
010-7040704
y.vanderdoes@erasmusmc.nl
Inclusion criteria
In order to be eligible to participate in this study, a subject must meet all of the following criteria:
• Fever: ear temperature> 38.1 0C
• Signed informed consent
• Aged 18 years or older
Exclusion criteria
A potential eligible subject who meets any of the following criteria will be excluded from participation in this study:
• Pregnancy.
• Immunocompromised patients (neutropenia, defined as an absolute neutrophil count less than 0.5x109/L, current chemotherapy, transplantation patients).
• Predetermined illness with an expected death within 24 hours.
• Surgical fever, defined as fever within 72 hours post-surgery, or patients with a primary surgical diagnosis.
Design
Recruitment
Followed up by the following (possibly more current) registration
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| NTR-new | NL4826 |
| NTR-old | NTR4949 |
| CCMO | NL44227.078.13 |
| OMON | NL-OMON41410 |
Summary results
Limper M, van der Does Y, Brandjes DP, De Kruif MD, Rood PP, van Gorp EC.
J Infect. 2014 Oct;69(4):410-2
PMID: 24820656