Résumé :
|
[BDSP. Notice produite par INIST-CNRS yVR0xoS5. Diffusion soumise à autorisation]. Background : Lower respiratory tract infections are often treated with antibiotics without evidence of clinically relevant bacterial disease. Serum calcitonin precursor concentrations, including procalcitonin, are raised in bacterial infections. We aimed to assess a procalcitonin-based therapeutic strategy to reduce antibiotic use in lower respiratory tract infections with a new rapid and sensitive assay. Methods 243 patients admitted with suspected lower respiratory tract infections were randomly assigned standard care (standard group ; n=119) or procalcitonin-guided treatment (procalcitonin group ; n=124). On the basis of serum procalcitonin concentrations, use of antibiotics was more or less discouraged (=0.5 mug/L or>=0.25 mug/L), respectively. Reevaluation was possible after 6-24 h in both groups. Primary endpoint was use of antibiotics and analysis was by intention to treat. Findings : Final diagnoses were pneumonia (n=87 ; 36%), acute exacerbation of chronic obstructive pulmonary disease (60 ; 25%), acute bronchitis (59 ; 24%), asthma (13 ; 5%), and other respiratory affections (24 ; 10%). Serological evidence of viral infection was recorded in 141 of 175 tested patients (81%). Bacterial cultures were positive from sputum in 51 (21%) and from blood in 16 (7%). In the procalcitonin group, the adjusted relative risk of antibiotic exposure was 0.49 (95% Cl 0.44-0.55 ; p
|