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Master Thesis

Les médecins sont-ils prêts à faire confiance à la procalcitonine pour guider la mise sous antibiotiques dans l’exacerbation de BPCO ?

Abstract : BACKGROUND: Prescribing antibiotics in COPD exacerbations isn’t an easy decision for physicians. Procalcitonin is a useful biomarker, which helps to decrease antibiotherapy in this case, even if it is rarely used. We evaluated the impact of the introduction of a protocol based on procalcitonin algorithm to guide antibiotic prescriptions in patients experiencing exacerbations of COPD. METHODS: We performed an observational, retrospective, before/after study, in the University hospital of North Reunion. All patients with the final diagnostic of COPD exacerbation were analyzed, excepted patients in critical care units. First we observed physician practices regarding PCT and antibiotherapy, and then we analyzed the rate of antibiotics prescriptions and PCT measurement before and after introduction of a protocol validated by previous studies. The primary endpoint was the physicians’ adherence to this protocol. Secondary outcomes were rate of antibiotics prescriptions, length of hospitalization, death, and rehospitalizations. RESULTS: A total of 124 patients requiring hospitalization for COPD exacerbation before protocol and 121 patients after were analyzed. Protocol adherence was completed in 55% of cases, and partially (no PCT guidance for discontinue antibiotherapy) in 68% of cases. Antibiotic prescriptions rate decreased by 41% after protocol introduction (59% vs. 35%, p<0.001), without increasing morbidity-mortality after 30 days. Antibiotherapy duration didn’t change (8.3 d vs. 8.7d), as the length of hospitalization (8.5 days vs. 8.3 days, p=0.78). CONCLUSION: Hospital physicians already trust procalcitonin algorithm for antibiotic guidance in COPD exacerbations. Its properly use (threshold value and follow-up) should be clarified in hospitals to reduce antibiotics prescriptions of this overexposed population.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01089391
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Submitted on : Monday, December 1, 2014 - 4:08:09 PM
Last modification on : Wednesday, August 23, 2017 - 4:41:14 PM
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Jeanne Picart. Les médecins sont-ils prêts à faire confiance à la procalcitonine pour guider la mise sous antibiotiques dans l’exacerbation de BPCO ?. Médecine humaine et pathologie. 2014. ⟨dumas-01089391⟩

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