Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries: adaptation based on an expert consensus meeting.

Lee CC; Kwa ALH; Apisarnthanarak A; Feng JY; Gluck EH; Ito A; Karuniawati A; Periyasamy P; Pratumvinit B; Sharma J; Solante R; Swaminathan S; Tyagi N; Vu DM; Zirpe K; Schuetz P

doi:10.1515/cclm-2019-1122

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Journal article

Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries: adaptation based on an expert consensus meeting.

Lee CC National Taiwan University Hospital, Emergency Medicine Department and Health Data Science Research Group, Taipei, Taiwan.
Kwa ALH Singapore General Hospital, Singapore, Singapore.
Apisarnthanarak A Thammasart University Hospital, Division of Infectious Diseases, Bangkok, Thailand.
Feng JY Taipei Veterans General Hospital, Department of Chest Medicine, Taipei, Taiwan.
Gluck EH Swedish Covenant Hospital, Critical Care Services, Chicago, IL, USA.
Ito A Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan.
Karuniawati A Department of Microbiology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Periyasamy P Infectious Disease Unit, PPUKM (HCTM), Hospital Canselor Tuanku Muhriz UKM (HCTM), Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
Pratumvinit B Faculty of Medicine Siriraj Hospital, Department of Clinical Pathology, Mahidol University, Bangkok, Thailand.
Sharma J Artemis Hospital Critical Care Medicine, Gurgaon, India.
Solante R San Lazaro Hospital, Adult Infectious Diseases and Tropical Medicine, Manila, Philippines.
Swaminathan S Gleneagles Global Hospitals, Infectious Diseases, Chennai and Bengaluru, India.
Tyagi N Sir Ganga Ram Hospital, Institute of Critical Care and Emergency Medicine, Delhi, India.
Vu DM Critical Care Department, National Hospital of Tropical Diseases, Hanoi, Vietnam.
Zirpe K Department of Neuro Critical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, India.
Schuetz P Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.

2020-01-12

Published in:

Clinical chemistry and laboratory medicine. - 2020

English Introduction Recently, an expert consensus on optimal use of procalcitonin (PCT)-guided antibiotic stewardship was published focusing mainly on Europe and the United States. However, for Asia-Pacific countries, recommendations may need adaptation due to differences in types of infections, available resources and standard of clinical care. Methods Practical experience with PCT-guided antibiotic stewardship was discussed among experts from different countries, reflecting on the applicability of the proposed Berlin consensus algorithms for Asia-Pacific. Using a Delphi process, the group reached consensus on two PCT algorithms for the critically ill and the non-critically ill patient populations. Results The group agreed that the existing evidence for PCT-guided antibiotic stewardship in patients with acute respiratory infections and sepsis is generally valid also for Asia-Pacific countries, in regard to proposed PCT cut-offs, emphasis on diagnosis, prognosis and antibiotic stewardship, overruling criteria and inevitable adaptations to clinical settings. However, the group noted an insufficient database on patients with tropical diseases currently limiting the clinical utility in these patients. Also, due to lower resource availabilities, biomarker levels may be measured less frequently and only when changes in treatment are highly likely. Conclusions Use of PCT to guide antibiotic stewardship in conjunction with continuous education and regular feedback to all stakeholders has high potential to improve the utilization of antibiotic treatment also in Asia-Pacific countries. However, there is need for adaptations of existing algorithms due to differences in types of infections and routine clinical care. Further research is needed to understand the optimal use of PCT in patients with tropical diseases.

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