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

Chien Chang Lee, Andrea Lay Hoon Kwa, Anucha Apisarnthanarak, Jia Yih Feng, Eric Howard Gluck, Akihiro Ito, Anis Karuniawati, Petrick Periyasamy, Busadee Pratumvinit, Jeetendra Sharma, Rontgene Solante, Subramanian Swaminathan, Niraj Tyagi, Dien Minh Vu, Kapil Zirpe, Philipp Schuetz

Research output: Contribution to journalArticle

Abstract

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. 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. 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. 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.

Original languageEnglish
JournalClinical Chemistry and Laboratory Medicine
DOIs
Publication statusAccepted/In press - 1 Jan 2020

Fingerprint

Calcitonin
Consensus
Anti-Bacterial Agents
Group Processes
Biomarkers
Berlin
Standard of Care
Infection
Critical Illness
Respiratory Tract Infections
Sepsis
Education
Availability
Databases
Feedback
Therapeutics
Research
Population

Keywords

  • antibiotic stewardship
  • Asia-Pacific
  • bacterial infection
  • biomarker
  • procalcitonin
  • respiratory tract infections
  • sepsis

Cite this

Lee, Chien Chang ; Kwa, Andrea Lay Hoon ; Apisarnthanarak, Anucha ; Feng, Jia Yih ; Gluck, Eric Howard ; Ito, Akihiro ; Karuniawati, Anis ; Periyasamy, Petrick ; Pratumvinit, Busadee ; Sharma, Jeetendra ; Solante, Rontgene ; Swaminathan, Subramanian ; Tyagi, Niraj ; Vu, Dien Minh ; Zirpe, Kapil ; Schuetz, Philipp. / Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries : Adaptation based on an expert consensus meeting. In: Clinical Chemistry and Laboratory Medicine. 2020.
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abstract = "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. 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. 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. 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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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 2020, 'Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries: Adaptation based on an expert consensus meeting', Clinical Chemistry and Laboratory Medicine. https://doi.org/10.1515/cclm-2019-1122

Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries : Adaptation based on an expert consensus meeting. / Lee, Chien Chang; Kwa, Andrea Lay Hoon; Apisarnthanarak, Anucha; Feng, Jia Yih; Gluck, Eric Howard; Ito, Akihiro; Karuniawati, Anis; Periyasamy, Petrick; Pratumvinit, Busadee; Sharma, Jeetendra; Solante, Rontgene; Swaminathan, Subramanian; Tyagi, Niraj; Vu, Dien Minh; Zirpe, Kapil; Schuetz, Philipp.

In: Clinical Chemistry and Laboratory Medicine, 01.01.2020.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Procalcitonin (PCT)-guided antibiotic stewardship in Asia-Pacific countries

T2 - Adaptation based on an expert consensus meeting

AU - Lee, Chien Chang

AU - Kwa, Andrea Lay Hoon

AU - Apisarnthanarak, Anucha

AU - Feng, Jia Yih

AU - Gluck, Eric Howard

AU - Ito, Akihiro

AU - Karuniawati, Anis

AU - Periyasamy, Petrick

AU - Pratumvinit, Busadee

AU - Sharma, Jeetendra

AU - Solante, Rontgene

AU - Swaminathan, Subramanian

AU - Tyagi, Niraj

AU - Vu, Dien Minh

AU - Zirpe, Kapil

AU - Schuetz, Philipp

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