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
N1 - Publisher Copyright:
© 2020 Philipp Schuetz et al., published by De Gruyter, Berlin/Boston.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - 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.
AB - 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.
KW - antibiotic stewardship
KW - Asia-Pacific
KW - bacterial infection
KW - biomarker
KW - procalcitonin
KW - respiratory tract infections
KW - sepsis
UR - http://www.scopus.com/inward/record.url?scp=85078219846&partnerID=8YFLogxK
U2 - 10.1515/cclm-2019-1122
DO - 10.1515/cclm-2019-1122
M3 - Article
C2 - 31926074
AN - SCOPUS:85078219846
SN - 1434-6621
VL - 58
JO - Clinical Chemistry and Laboratory Medicine
JF - Clinical Chemistry and Laboratory Medicine
IS - 12
ER -