DOCSLIB.ORG

Procalcitonin-Guided Antibiotic Therapy Comparative Effectiveness Review Number 78

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Procalcitonin-Guided Antibiotic Therapy Comparative Effectiveness Review Number 78 Comparative Effectiveness Review Number 78 Procalcitonin-Guided Antibiotic Therapy Comparative Effectiveness Review Number 78 Procalcitonin-Guided Antibiotic Therapy Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10058-I Prepared by: Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center Chicago, IL Investigators: Nilam J. Soni, M.D. David J. Samson, M.S. Jodi L. Galaydick, M.D. Vikrant Vats, Ph.D. David L. Pitrak, M.D. Naomi Aronson, Ph.D. AHRQ Publication No. 12(13)-EHC124-EF October 2012 This report is based on research conducted by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007- 10058-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This document is in the public domain and may be used and reprinted without special permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. Suggested citation: Soni NJ, Samson DJ, Galaydick JL, Vats V, Pitrak DL, Aronson N. Procalcitonin-Guided Antibiotic Therapy. Comparative Effectiveness Review No. 78. (Prepared by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. 290-2007-10058-I.) AHRQ Publication No. 12(13)-EHC124- EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to organize knowledge and make it available to inform decisions about health care. As part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Congress directed AHRQ to conduct and support research on the comparative outcomes, clinical effectiveness, and appropriateness of pharmaceuticals, devices, and health care services to meet the needs of Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). AHRQ has an established network of Evidence-based Practice Centers (EPCs) that produce Evidence Reports/Technology Assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care. The EPCs now lend their expertise to the Effective Health Care Program by conducting comparative effectiveness reviews (CERs) of medications, devices, and other relevant interventions, including strategies for how these items and services can best be organized, managed, and delivered. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews are useful because they define the strengths and limits of the evidence, clarifying whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm. AHRQ expects that CERs will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. In addition, AHRQ is committed to presenting information in different formats so that consumers who make decisions about their own and their family’s health can benefit from the evidence. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input. Comparative effectiveness reviews will be updated regularly. We welcome comments on this CER. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Supriya Janakiraman, M.D., M.P.H. Director, EPC Program Task Order Officer Center for Outcomes and Evidence Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iii Acknowledgments The authors gratefully acknowledge the following individuals for their contributions to this project: Claudia Bonnell, R.N., M.L.S.; Lisa Garofalo; Mark Grant, M.D., M.P.H.; Steven Gutman, M.D.; Lisa Sarsany, M.A.; Kathleen Ziegler, Pharm.D.; Elbert Huang, M.D., M.P.H; Ronald Thisted, Ph.D.; Michael Douglas, M.S.; and Jessica Hoag, B.A. Technical Expert Panel R. Phillip Dellinger, M.D. Joshua Metlay, M.D., Ph.D. Head, Critical Care Medicine Professor of Medicine, Epidemiology, and Cooper University Hospital Emergency Medicine Camden, NJ Perelman School of Medicine University of Pennsylvania Jesse Hall, M.D. Philadelphia, PA Section Chief, Pulmonary and Critical Care Medicine Emanuel Rivers, M.D., M.P.H. University of Chicago Vice Chair and Director of Research for the Chicago, IL Department of Emergency Medicine Henry Ford Hospital Stephen Kahn, Ph.D. Detroit, MI Associate Director, Clinical Laboratories Loyola University Chicago Gregory Schmidt, M.D. Maywood, IL Director, Critical Care Programs University of Iowa Henry Masur, M.D. Iowa City, IA Chief, Critical Care Medicine National Institutes of Health Bethesda, MD Peer Reviewers Derek Angus, M.D., M.P.H. Rongwei (Rochelle) Fu, Ph.D. Professor and Chair, Critical Care Medicine Associate Professor Professor, Medicine and Health Policy Oregon Health & Science University and Management Portland, OR University of Pittsburgh School of Medicine Pittsburgh, PA iv Procalcitonin-Guided Antibiotic Therapy Structured Abstract Objectives. To systematically review comparative studies of the use of procalcitonin in the clinical management of adult and pediatric patients with suspected local or systemic infection. Data sources. MEDLINE®, Embase®, the Cochrane Database of Systematic Reviews, National Institute for Clinical Excellence, the National Guideline Clearinghouse, and the Health Technology Assessment Programme were searched from January 1, 1990, to December 16, 2011; the MEDLINE, Embase, and Cochrane searches were updated in December 2011. A search of the gray literature included databases with regulatory information, clinical trial registries, abstracts and conference papers, grants and federally funded research, and information from manufacturers. Review methods. We sought studies that compared procalcitonin-guided versus clinical-criteria- guided initiation, discontinuation, or change of antibiotic therapy. Outcomes were antibiotic use, mortality, morbidity, and adverse drug events of antibiotic therapy. Data were abstracted by a single reviewer and fact-checked by a second reviewer. Study quality was assessed using the U.S. Preventive Services Task Force framework. A meta-analysis on short-term mortality in intensive care unit (ICU) patients was performed using a random-effects model. Strength of the body of evidence was assessed according to the AHRQ Methods Guide. Results. There were 18 randomized, controlled trials that addressed five patient populations. Procalcitonin guidance reduces antibiotic use when used to discontinue antibiotics in adult ICU patients and to initiate or discontinue antibiotics in patients with respiratory tract infections (high evidence), without increasing morbidity (moderate evidence) and mortality (low evidence). In contrast, procalcitonin-guided
Load more

Recommended publications
  • Diagnostic Accuracy of Procalcitonin in Critically Ill Immunocompromised
    Bele et al. BMC Infectious Diseases 2011, 11:224 http://www.biomedcentral.com/1471-2334/11/224 RESEARCHARTICLE Open Access Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients Nicolas Bele1, Michael Darmon1,2,3, Isaline Coquet1, Jean-Paul Feugeas4, Stéphane Legriel1, Nadir Adaoui4, Benoît Schlemmer1 and Élie Azoulay1* Abstract Background: Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT) in critically ill immunocompromised patients. Methods: This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis. Results: We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years). The general severity (SAPSII) and organ dysfunction (LOD) scores on day 1 were 45 (35-62.7) and 4 (2-6), respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%), HIV infection (31 patients, 26%), and solid cancers (26 patients, 21.8%). Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%); 52 patients (43.7%) had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09- 1.26] ng/ml in patients without bacterial infection, P < 0.0001). PCT concentrations on day 1 that were > 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC) curve was 0.851 (0.78-0.92).
    [Show full text]
  • Polymicrobial Septic Shock with Multiorgan Dysfunction in An
    JOMA Polymicrobial Septic Shock10.5005/jp-journals-100 with Multiorgan Dysfunction70-0012 CASE REPORT Polymicrobial Septic Shock with Multiorgan Dysfunction in an Otherwise Healthy Immunocompetent Patient 1Anuradha Makkar, 2Inam D Khan, 3KS Rajmohan, 4Syed A Hashmi, 5Lakshmi Nair, 6Alpana Gupta, 7Harleen Chopra, 8Priyanka Banerjee, 9Pragyan S Panda, 10Rajiv M Gupta ABSTRACT Source of support: Nil Background: Sepsis is a significant cause of morbidity and Conflict of interest: None mortality worldwide despite advanced critical life-support. Septic shock and multiorgan dysfunction is the terminal stage INTRODUCTION in critically ill patients leading to perfusion abnormalities, lactic acidosis, oliguria and altered mental status creating a rapid Sepsis is a major cause of morbidity and mortality world- downhill course and mortality. Sepsis ensues through stages wide despite advanced critical life-support. It is the 11th - of exaggerated immune response including systemic inflamma leading cause of death overall with attributable mortality tory response syndrome, in the backdrop of infectious stimuli. to sepsis and severe sepsis being 30 to 50% and 50 to 60%. Case report: Polymicrobial septic shock with multiorgan Following a non-infectious or infectious insult, there is dysfunction leads to demise in an otherwise healthy immuno- competent patient. Microbiological profile revealedEscherichia a preliminary systemic response which becomes over- coli urinary tract infection (UTI), Staphylococcus sciuri bactere- whelming leading to systemic inflammatory response mia, Acinetobacter baumanii ventilator-associated pneumonia, syndrome. When the compensatory anti-inflammatory and central line catheter tip Pseudomonas aeruginosa, thereby reaction fails, it leads to immunomodulatory failure, pointing towards polymicrobial sepsis. Neutropenia of 290/ dL along with serum procalcitonin 5 ng/mL was detected.
    [Show full text]
  • 'Risk Factors for Candidemia: a Prospective Matched Case-Control
    Poissy et al. Critical Care (2020) 24:109 https://doi.org/10.1186/s13054-020-2766-1 RESEARCH Open Access Risk factors for candidemia: a prospective matched case-control study Julien Poissy1,2,3 , Lauro Damonti3,4, Anne Bignon5, Nina Khanna6, Matthias Von Kietzell7, Katia Boggian7, Dionysios Neofytos8, Fanny Vuotto9, Valérie Coiteux10, Florent Artru11, Stephan Zimmerli4, Jean-Luc Pagani12, Thierry Calandra3, Boualem Sendid2,13, Daniel Poulain2,13, Christian van Delden8, Frédéric Lamoth3,14, Oscar Marchetti3,15, Pierre-Yves Bochud3*, the FUNGINOS and Allfun French Study Groups Abstract Background: Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs. Methods: This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia. Results: One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics.
    [Show full text]
  • Annual Meeting
    Volume 97 | Number 5 Volume VOLUME 97 NOVEMBER 2017 NUMBER 5 SUPPLEMENT SIXTY-SIXTH ANNUAL MEETING November 5–9, 2017 The Baltimore Convention Center | Baltimore, Maryland USA The American Journal of Tropical Medicine and Hygiene The American Journal of Tropical astmh.org ajtmh.org #TropMed17 Supplement to The American Journal of Tropical Medicine and Hygiene ASTMH FP Cover 17.indd 1-3 10/11/17 1:48 PM Welcome to TropMed17, our yearly assembly for stimulating research, clinical advances, special lectures, guests and bonus events. Our keynote speaker this year is Dr. Paul Farmer, Co-founder and Chief Strategist of Partners In Health (PIH). In addition, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, will deliver a plenary session Thursday, November 9. Other highlighted speakers include Dr. Scott O’Neill, who will deliver the Fred L. Soper Lecture; Dr. Claudio F. Lanata, the Vincenzo Marcolongo Memorial Lecture; and Dr. Jane Cardosa, the Commemorative Fund Lecture. We are pleased to announce that this year’s offerings extend beyond communicating top-rated science to direct service to the global community and a number of novel events: • Get a Shot. Give a Shot.® Through Walgreens’ Get a Shot. Give a Shot.® campaign, you can not only receive your free flu shot, but also provide a lifesaving vaccine to a child in need via the UN Foundation’s Shot@Life campaign. • Under the Net. Walk in the shoes of a young girl living in a refugee camp through the virtual reality experience presented by UN Foundation’s Nothing But Nets campaign.
    [Show full text]
  • Procalcitonin and Its Limitations: Why a Biomarker's Best Isn't Good Enough
    POINT/COUNTERPOINT Counterpoint Procalcitonin and Its Limitations: Why a Biomarker's Best Isn't Good Enough Ayesha Farooq1 and Jessica M. Colón-Franco1* Sepsis-related conditions remain the leading Intended uses now include supporting antibiotic Downloaded from https://academic.oup.com/jalm/article/3/4/716/5603063 by guest on 23 September 2021 causes of mortality, morbidity, and expenditures management decisions in respiratory infections worldwide despite efforts to standardize care and and sepsis. There is no reference method for PCT. expedite diagnosis and treatment, which are de- The BRAHMS Kryptor sensitive PCT assay (Thermo- terminants of outcome. As with most syndromes Fisher Scientific) and its predecessor were initially with complex pathophysiology, no gold standard available and used to derive PCT cutoffs. The diagnostic test exists. Diagnosis is complicated by BRAHMS assay can be run in automated immuno- nonspecific symptoms and lengthy blood cultures assay instruments from partner companies. Simi- with high false-negative rates. Empiric antibiotic larly, the Diazyme PCT immunotubidimetric assay treatment upon signs of sepsis is an increasing (Diazyme Laboratories) can be implemented in concern for antibiotic overuse and resistance. The common chemistry analyzers. This widespread need for biochemical biomarkers for sepsis diag- availability of PCT assays is facilitating clinical use nosis is well accepted. Several pro- and antiinflam- but analytical considerations come into play. The matory biomarkers have been investigated, but functional sensitivity of the Diazyme PCT assay is only few are incorporated in clinical practice (1). higher than the BRAHMS assay and above the Procalcitonin (PCT)2 is one such molecule that reference interval of healthy individuals (2, 3).
    [Show full text]
  • Procalcitonin (PCT)
    Procalcitonin (PCT) Guidance Background: Up to 50% of antimicrobial use in the inpatient setting is unneeded or inappropriate.1 For example, viruses are typically the cause of acute bronchitis but despite this as much as 80% of patients will be prescribed antibiotics.2 Also the length of treatment for most infections has been poorly studied and it is likely that treatment durations are inappropriately long.3 The appropriate use of antimicrobials is essential because they are associated with patient harm including drug toxicity, increased drug resistance, and collateral damage such as Clostridium diffiicile-associated diarrhea.4-6 Procalcitonin has been evaluated as a biomarker to assist the clinician in the diagnosis and treatment of bacterial infection. Procalcitonin has been studied most thoroughly for lower respiratory tract infections and sepsis and its use is associated with decreased antimicrobial usage without worsening of clinical outcomes.7-13 What is Procalcitonin?14-16 Procalcitonin (PCT) is a 116 amino acid precursor of calcitonin which under normal circumstances is produced by the thyroid C-cells. Serum concentrations of PCT are normally <0.05 ng/mL but in circumstances of systemic inflammation, particularly bacterial infection, PCT is produced in large quantities by many body tissues. It is detectable within 2-4 hours and peaks within 6-24 hours (as opposed to CRP which begins to rise after 12-24 hours and peaks at 48 hours). 14-16 PCT production is not impaired by neutropenia or other immunosuppressive states. PCT levels parallel the severity of the inflammatory insult or infection meaning those with more severe disease have higher levels.
    [Show full text]
  • Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting
    Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting a b,c, Alexander Lepak, MD , David Andes, MD * KEYWORDS Invasive candidiasis Pharmacokinetics-pharmacodynamics Therapy Source control Invasive fungal infections (IFI) and fungal sepsis in the intensive care unit (ICU) are increasing and are associated with considerable morbidity and mortality. In this setting, IFI are predominantly caused by Candida species. Currently, candidemia represents the fourth most common health care–associated blood stream infection.1–3 With increasingly immunocompromised patient populations, other fungal species such as Aspergillus species, Pneumocystis jiroveci, Cryptococcus, Zygomycetes, Fusarium species, and Scedosporium species have emerged.4–9 However, this review focuses on invasive candidiasis (IC). Multiple retrospective studies have examined the crude mortality in patients with candidemia and identified rates ranging from 46% to 75%.3 In many instances, this is partly caused by severe underlying comorbidities. Carefully matched, retrospective cohort studies have been undertaken to estimate mortality attributable to candidemia and report rates ranging from 10% to 49%.10–15 Resource use associated with this infection is also significant. Estimates from numerous studies suggest the added hospital cost is as much as $40,000 per case.10–12,16–20 Overall attributable costs are difficult to calculate with precision, but have been estimated to be close to 1 billion dollars in the United States annually.21 a University of Wisconsin, MFCB, Room 5218, 1685 Highland Avenue, Madison, WI 53705-2281, USA b Department of Medicine, University of Wisconsin, MFCB, Room 5211, 1685 Highland Avenue, Madison, WI 53705-2281, USA c Department of Microbiology and Immunology, University of Wisconsin, MFCB, Room 5211, 1685 Highland Avenue, Madison, WI 53705-2281, USA * Corresponding author.
    [Show full text]
  • Procalcitonin and C-Reactive Protein in the Diagnosis of Spontaneous Bacterial Peritonitis
    10 Original Article Procalcitonin and C-reactive protein in the diagnosis of spontaneous bacterial peritonitis Rajanshu Verma1, Sanjaya K. Satapathy2,3, Muhammad Bilal4 1Transplant Hepatology/Gastroenterology fellow, University of Tennessee Health Sciences Center, Memphis, TN, USA; 2Department of Transplant Surgery, Methodist University Hospital Transplant Institute/University of Tennessee Health Sciences Center, Memphis, TN, USA; 3Medical Director of Liver Transplantation, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases and Liver Transplantation, Northwell Health/North Shore University Hospital, Manhasset, New York, USA; 4Department of Gastroenterology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA Contributions: (I) Conception and design: M Bilal; (II) Administrative support: SK Satapathy, M Bilal; (III) Provision of study materials or patients: M Bilal; (IV) Collection and assembly of data: M Bilal, R Verma; (V) Data analysis and interpretation: R Verma, SK Satapathy; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Muhammad Bilal, MD. Department of Gastroenterology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA. Email: [email protected]. Background: Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis and is associated with high morbidity and mortality. Rapid institution of appropriate antibiotics is central to the improved patient outcome. Correctly obtaining ascites fluid for analysis has several technical and logistic limitations resulting in overuse of empiric antibiotics when patients are admitted to the hospital with suspected SBP. Procalcitonin and C-reactive protein (CRP) are non-invasive markers of infection. We conducted a study to illustrate the role of these markers in making the diagnosis of SBP in patients with cirrhosis.
    [Show full text]
  • Procalcitonin-Guided Interventions Against Infections to Increase Early Appropriate Antibiotics and Improve Survival in the Intensive Care Unit: a Randomized Trial
    Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: A randomized trial Jens U. Jensen, MD, PhD; Lars Hein, MD; Bettina Lundgren, MD, DMSc; Morten H. Bestle, MD, PhD; Thomas T. Mohr, MD, PhD; Mads H. Andersen, MD; Klaus J. Thornberg, MD; Jesper Løken, MD; Morten Steensen, MD; Zoe Fox, MD, PhD; Hamid Tousi, MD; Peter Søe-Jensen, MD; Anne Ø. Lauritsen, MD; Ditte Strange, MD; Pernille L. Petersen, MD; Nanna Reiter, MD; Søren Hestad, MD; Katrin Thormar, MD; Paul Fjeldborg, MD; Kim M. Larsen, MD; Niels E. Drenck, MD; Christian Østergaard, MD, PhD, DMSc; Jesper Kjær, MSc; Jesper Grarup, DVM; Jens D. Lundgren, MD, DMSc; for the The Procalcitonin And Survival Study (PASS) Study Group Objective: For patients in intensive care units, sepsis is a were supplemented with a drug-escalation algorithm and inten- common and potentially deadly complication and prompt initia- sified diagnostics based on daily procalcitonin measurements. tion of appropriate antimicrobial therapy improves prognosis. The Measurements and Main Results: The primary end point was objective of this trial was to determine whether a strategy of death from any cause at day 28; this occurred for 31.5% (190 of antimicrobial spectrum escalation, guided by daily measurements 604) patients in the procalcitonin arm and for 32.0% (191 of 596) of the biomarker procalcitonin, could reduce the time to appro- patients in the standard-of-care-only arm (absolute risk reduc- priate therapy, thus improving survival. tion, 0.6%; 95% confidence interval [CI] ؊4.7% to 5.9%). Length ؍ Design: Randomized controlled open-label trial.
    [Show full text]
  • CHEMISTRY and IMMUNOASSAY ANALYZERS JULY 2018 | CAP TODAY 49
    CHEMISTRY AND IMMUNOASSAY ANALYZERS JULY 2018 | CAP TODAY 49 Part 1 of 15 Arlington Scientific Arlington Scientific Beckman Coulter Mike LaDow [email protected] Mike LaDow [email protected] Wendy Rodriguez [email protected] FOR MID– AND HIGH–VOLUME Springville, UT Springville, UT Brea, CA LABORATORIES 801-489-8911 www.arlingtonscientific.com 801-489-8911 www.arlingtonscientific.com 714-961-6679 www.beckmancoulter.com Name of instrument ASI Evolution Automated RPR Analyzer ASI Infinity EIA Analyzer DxC 700 AU Type of instrument immunoassay immunoassay chemistry Operational type/Model type batch/benchtop batch/benchtop continuous random access/floor standing List price/First year sold in U.S. $44,995/2018 $44,995/1998 —/2016 Targeted hospital bed size/Targeted daily test volume ≥20/>100 ≥20/20 —/300–2,250 samples Company manufactures instrument yes (also sold by Fisher Scientific, VWR) yes (also sold by Fisher Scientific, VWR) yes (also sold by Henry Schein, McKesson, Medline) Other models in this family of analyzers — — AU 480, AU 5800 No. of units in clinical use in U.S./Outside U.S. (countries) 4/— 80/4,350 58/100 Dimensions (H × W × D)/Instrument footprint (square feet) 19 × 36 × 22 in./6 sq. ft. 19 × 36 × 22 in./6 sq. ft. 51 × 78 × 41 in./40.1 sq. ft. Weight empty/Weight fully loaded 78 lbs./80 lbs. 78 lbs./80 lbs. 1,046 lbs./— Tests available on analyzer in U.S. ASI automated rapid plasma reagin test for syphilis for ASI infectious disease tests: VZV, EBV-VCA, rubella, CMV, complete general chemistry, proteins/serology, thyroid, diagnostic and blood donor screening EBV-NA, HSV, toxoplasma, measles, mumps; open tests esoterics, TDM, DAT panels, more from other manufacturers Tests not available in U.S.
    [Show full text]
  • Procalcitonin in the Diagnosis of Sepsis and Correlations with Upcoming Novel Diagnostic Markers
    INTERNATIONAL JOURNAL OF MEDICAL BIOCHEMISTRY DOI: 10.14744/ijmb.2019.30502 Int J Med Biochem 2019;2(3):132-40 Review Procalcitonin in the diagnosis of sepsis and correlations with upcoming novel diagnostic markers Mustafa Erinc Sitar1, Belkiz Ongen Ipek1, Asli Karadeniz2 1Department of Medical Biochemistry, Maltepe University Faculty of Medicine Education Research Hospital Central Laboratory, Istanbul, Turkey 2Department of Infectious Diseases and Clinical Microbiology, Maltepe University Faculty of Medicine Education Research Hospital Central Laboratory, Istanbul, Turkey Abstract Objectives: Sepsis is a complex and lethal condition. For successful treatment, clinicians need high quality testing to guide the approach to pathogen identification and treatment. Medical laboratories play a vital role in the detection of infectious agents, and must continually strive to discover new and reliable tests and to analyze the reliability of existing tests in different diseases and expand their usage as appropriate. Selecting the appropriate therapy, reducing the use of antibiotics and thereby reducing antibiotic resistance are also undeniable parts of this task. The most commonly used parameters to guide infection therapy are the white blood cell count, the erythrocyte sedimentation rate, the absolute count of neutrophils, the absolute number of lymphocytes, and the level of C-reactive protein, serum amyloid A pro- tein, ceruloplasmin, haptoglobin, fibrinogen, and procalcitonin (ProCT). Although ProCT has been accepted as quite effective in differentiating serious bacterial infections, there are unresolved questions regarding effective usage during follow-up, as there are with other markers. ProCT and other promising biomarkers in a sepsis setting were the focus of this review, beginning with the first study to define ProCT in the literature, and examining some of the studies related to the importance of the ProCT-sepsis relationship, and detailed information on candidate markers.
    [Show full text]
  • Born Too Soon: Care for the Preterm Baby
    Lawn et al. Reproductive Health 2013, 10(Suppl 1):S5 http://www.reproductive-health-journal.com/content/10/S1/S5 REVIEW Open Access Born Too Soon: Care for the preterm baby Joy E Lawn*1,2, Ruth Davidge3,4,5, Vinod K Paul6, Severin von Xylander7, Joseph de Graft Johnson8, Anthony Costello9, Mary V Kinney10, Joel Segre11 and Liz Molyneux12 Abstract As part of a supplement entitled “Born Too Soon”, this paper focuses on care of the preterm newborn. An estimated 15 million babies are born preterm, and the survival gap between those born in high and low income countries is widening, with one million deaths a year due to direct complications of preterm birth, and around one million more where preterm birth is a risk factor, especially amongst those who are also growth restricted. Most premature babies (>80%) are between 32 and 37 weeks of gestation, and many die needlessly for lack of simple care. We outline a series of packages of care that build on essential care for every newborn comprising support for immediate and exclusive breastfeeding, thermal care, and hygienic cord and skin care. For babies who do not breathe at birth, rapid neonatal resuscitation is crucial. Extra care for small babies, including Kangaroo Mother Care, and feeding support, can halve mortality in babies weighing <2000 g. Case management of newborns with signs of infection, safe oxygen management and supportive care for those with respiratory complications, and care for those with signifi cant jaundice are all critical, and are especially dependent on competent nursing care. Neonatal intensive care units in high income settings are de-intensifying care, for example increasing use of continuous positive airway pressure (CPAP) and this makes comprehensive preterm care more transferable.
    [Show full text]