Original Title: Dosage de la procalcitonine afin d'optimiser l'utilisation des antibiotiques dans le traitement des infections

Authors' objectives: In the intensive care, the emergency department, and on care units, clinical teams must manage users suffering from infections of different etiologies, requiring prompt and appropriate use of antibiotics. The inappropriate use of antibiotics in the management of infections for which a bacterial cause has not been confirmed is, however, associated with the overuse of antibiotics, an important public health problem. The use of biomarkers to optimize the use of antibiotics is a strategy increasingly discussed in the scientific literature. Procalcitonin (PCT) is a prohormone, the level of which is directly correlated with the level of microbial toxins (endotoxins), or indirectly through the host immune response and the levels of various cytokines. The PCT assay could, therefore, be used in decision-making regarding the initiation or discontinuation of antibiotic treatment. However, the benefit of PCT in the management of bacterial infections, as well as the threshold values guiding its use, lack consensus among the scientific community. In this context, the Multidisciplinary Department of Pneumology and Thoracic Surgery at the Quebec Health and Lung Institute – Laval University (Institute) requested that the Health Technology Assessment Unit (HTAU) assess the relevance of the PCT assay to determine the initiation or discontinuation of antibiotics in the treatment of infections.

Authors' recommendations: Following the analysis of the data identified in the literature search, the HTAU recommends that the Institute include the PCT assay in order to optimize decisions related to the use of antibiotics in the treatment of infections. It is also suggested that the Institute revise the current antimicrobial stewardship program to include criteria for the optimal and efficient use of PCT. The HTAU made recommendations related to the development of three PCT-based algorithms to guide decisions regarding the use of antibiotics. In the first algorithm, it is recommended that PCT be used to guide decisions regarding the initial use of antibiotic therapy in patients with bronchitis and exacerbations of chronic obstructive pulmonary disease. In the second algorithm, it is recommended to use PCT to help decide whether to continue or discontinue antibiotic therapy in patients with community-, hospital-, or ventilator-associated pneumonia. In the last algorithm, it is recommended that PCT be used to aid in the decision whether to continue or discontinue antibiotic therapy in intensive care patients and those with sepsis.

Project Status: Completed

URL for project: https://www.iucpq.ca/a-propos-de-nous/excellence/evaluation-des-technologies-et-modes-dintervention-en-sante/

Year Published: 2022

URL for published report: https://www.iucpq.ca/app/uploads/2024/06/rap_procalcitonine_vf.pdf

Requestor: Multidisciplinary Services Directorate

English language abstract: There is no English language summary available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut universitaire de cardiologie et de pneumologie de Québec – Université Laval (IUCPQ-ULaval)

Contact Address: 2725, chemin Sainte-Foy Québec QC G1V 4G5

Contact Name: uetmis.iucpq@ssss.gouv.qc.ca

Contact Email: uetmis.iucpq@ssss.gouv.qc.ca

Copyright: Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval