Procalcitonin and Lung Ultrasonography Guided Antibiotherapy in Emergency Departments

Summary

Acute respiratory infections are a common reason of attendance at emergency departments. It is also the main reason of unnecessary antibiotic prescription. Antibiotics save lives, but can also directly harm patients by causing antibiotic-associated adverse events. Antibiotic use is directly related to resistance, which is one of the major threats of our century. In addition, some microorganisms live in and on the human body and promote many aspects of our health. Antibiotic treatment can disturb those microorganisms and therefore have long-lasting negative effects on our health.

Unfortunately, it is difficult to differentiate between viral infections, which usually heal spontaneously, and bacterial pneumonia, which needs antibiotics treatment. This is one of the reasons of this over-prescribing of antibiotics.

This project aims to reduce widespread use of antibiotics in the emergency department through a new diagnostic strategy of bacterial pneumonia. This strategy includes sequential use of well-known techniques: a clinical score, lung ultrasound and finally a biomarker, procalcitonin. The latter tends to be higher in bacterial infections. The combination of these different tests improves the diagnostic process and allows improved use of targeted antibiotics, with the ultimate goal of better patient management.

The study will compare the antibiotic prescription rate and the clinical course of patients managed using this new diagnostic approach with those managed as usual. The project will also evaluate the acceptability and feasibility of this strategy and its cost-effectiveness. These two aspects are essential for a wider implementation of this innovative diagnostic approach and decrease antibiotic resistance.

Conditions

• Lower Respiratory Tract Infection

Interventions

OTHER

The PLUS algorithm

Combination of a clinical prediction score and LUS, and if needed PCT measurement

OTHER

Usual care

Management as usual

Sponsors & Collaborators

• Cantonal Hospital of St. Gallen

  collaborator OTHER

• University Hospital, Basel, Switzerland

  collaborator OTHER

• Kantonsspital Baden

  collaborator OTHER

• Hôpital Intercantonal de la Broye, Payerne, Switzerland

  collaborator UNKNOWN

• Réseau Hospitalier Neuchâtelois

  collaborator OTHER

• Hôpital Riviera-Chablais, Vaud-Valais

  collaborator OTHER

• Luzerner Kantonsspital

  collaborator OTHER

• Cantonal Hosptal, Baselland

  collaborator OTHER

• St. Claraspital AG

  collaborator OTHER

• Dr Boillat-Blanco Noemie

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

DIAGNOSTIC

Masking

NONE

Model

SEQUENTIAL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2022-12-05

Primary Completion

2025-03-15

Completion

2025-06-11

Countries

• Switzerland

Study Locations