Procalcitonin and pyuria-based algorithm reduces antibiotic use in urinary tract infections: a randomized controlled trial

Publication

Procalcitonin and pyuria-based algorithm reduces antibiotic use in urinary tract infections: a randomized controlled trial

Journal Paper/Review - May 1, 2015

Drozdov Daniel, Buchkremer Florian, Haubitz Sebastian, Blum Claudine, Huber Andreas, Buergi Ulrich, Schuetz Philipp, Bock Andreas, Fux Christoph Andreas, Mueller Beat, Ottiger Cornelia, Reutlinger Barbara, Schwarz Stefanie, Kutz Alexander, Grolimund Eva, Rast Anna Christina, Steiner Deborah, Regez Katharina, Schild Ursula, Guglielmetti Merih, Conca Antoinette, Albrich Werner

Citation

Drozdov D, Buchkremer F, Haubitz S, Blum C, Huber A, Buergi U, Schuetz P, Bock A, Fux C, Mueller B, Ottiger C, Reutlinger B, Schwarz S, Kutz A, Grolimund E, Rast A, Steiner D, Regez K, Schild U, Guglielmetti M, Conca A, Albrich W. Procalcitonin and pyuria-based algorithm reduces antibiotic use in urinary tract infections: a randomized controlled trial. BMC Med 2015; 13:104.

Type

Journal Paper/Review (English)

Journal

BMC Med 2015; 13

Publication Date

May 1, 2015

Issn Electronic

1741-7015

Pages

104

Brief description/objective

BACKGROUND
Urinary tract infections (UTIs) are common drivers of antibiotic use. The minimal effective duration of antibiotic therapy for UTIs is unknown, but any reduction is important to diminish selection pressure for antibiotic resistance, costs, and drug-related side-effects. The aim of this study was to investigate whether an algorithm based on procalcitonin (PCT) and quantitative pyuria reduces antibiotic exposure.

METHODS
From April 2012 to March 2014, we conducted a factorial design randomized controlled open-label trial. Immunocompetent adults with community-acquired non-catheter-related UTI were enrolled in the emergency department of a tertiary-care 600-bed hospital in northwestern Switzerland. Clinical presentation was used to guide initiation and duration of antibiotic therapy according to current guidelines (control group) or with a PCT-pyuria-based algorithm (PCT-pyuria group). The primary endpoint was overall antibiotic exposure within 90 days. Secondary endpoints included duration of the initial antibiotic therapy, persistent infection 7 days after end of therapy and 30 days after enrollment, recurrence and rehospitalizations within 90 days.

RESULTS
Overall, 394 patients were screened, 228 met predefined exclusion criteria, 30 declined to participate, and 11 were not eligible. Of these, 125 (76% women) were enrolled in the intention-to-treat (ITT) analysis and 96 patients with microbiologically confirmed UTI constituted the per protocol group; 84 of 125 (67%) patients had a febrile UTI, 28 (22%) had bacteremia, 5 (4%) died, and 3 (2%) were lost to follow-up. Overall antibiotic exposure within 90 days was shorter in the PCT-pyuria group than in the control group (median 7.0 [IQR, 5.0-14.0] vs. 10.0 [IQR, 7.0-16.0] days, P = 0.011) in the ITT analysis. Mortality, rates of persistent infections, recurrences, and rehospitalizations were not different.

CONCLUSIONS
A PCT-pyuria-based algorithm reduced antibiotic exposure by 30% when compared to current guidelines without apparent negative effects on clinical outcomes.

TRIAL REGISTRATION
Current controlled trials ISRCTN13663741 , date applied: 22/05/2012, date assigned: 03/07/2012, last edited: 28/01/2014.