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Open AccessArticle

Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease

1
DHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
2
IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
3
Service d’Accueil des Urgences, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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Département d’Aval des Urgences, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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Service de Médecine Interne, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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Service d’Immunologie Clinique et Maladies Infectieuses, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
7
Service de Biochimie, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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Département de Virologie, Bactériologie, Parasitologie-Mycologie, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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Unité U955, INSERM, Université Paris Est, 94010 Créteil, France
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French Sickle Cell Referral Center, Laboratory of Excellence GR-Ex, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
*
Author to whom correspondence should be addressed.
K.R. and S.G. contributed equally to this work.
J. Clin. Med. 2020, 9(11), 3718; https://doi.org/10.3390/jcm9113718
Received: 30 September 2020 / Revised: 12 November 2020 / Accepted: 16 November 2020 / Published: 19 November 2020
Acute chest syndrome (ACS) is a major complication of sickle-cell disease. Bacterial infection is one cause of ACS, so current guidelines recommend the routine use of antibiotics. We performed a prospective before–after study in medical wards and an intensive-care unit (ICU). During the control phase, clinicians were blinded to procalcitonin concentration results. We built an algorithm using the obtained measurements to hasten antibiotic cessation after three days of treatment if bacterial infection was not documented, and procalcitonin concentrations were all <0.5 μg/L. During the intervention period, the procalcitonin algorithm was suggested to physicians as a guide for antibiotic therapy. The primary endpoint was the number of days alive without antibiotics at Day 21. One-hundred patients were analyzed (103 ACS episodes, 60 in intervention phase). Possible or proven lung infection was diagnosed during 13% of all ACS episodes. The number of days alive without antibiotics at Day 21 was higher during the intervention phase: 15 [14–18] vs. 13 [13,14] days (p = 0.001). More patients had a short (≤3 days) antibiotic course during intervention phase: 31% vs 9% (p = 0.01). There was neither infection relapse nor pulmonary superinfection in the entire cohort. A procalcitonin-guided strategy to prescribe antibiotics in patients with ACS may reduce antibiotic exposure with no apparent adverse outcomes. View Full-Text
Keywords: sickle-cell disease; acute chest syndrome; procalcitonin; antibiotic; bacterial infection sickle-cell disease; acute chest syndrome; procalcitonin; antibiotic; bacterial infection
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MDPI and ACS Style

Razazi, K.; Gendreau, S.; Cuquemelle, E.; Khellaf, M.; Guillaud, C.; Godeau, B.; Melica, G.; Moutereau, S.; Gomart, C.; Fourati, S.; De Prost, N.; Carteaux, G.; Brun-Buisson, C.; Bartolucci, P.; Habibi, A.; Mekontso Dessap, A. Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease. J. Clin. Med. 2020, 9, 3718. https://doi.org/10.3390/jcm9113718

AMA Style

Razazi K, Gendreau S, Cuquemelle E, Khellaf M, Guillaud C, Godeau B, Melica G, Moutereau S, Gomart C, Fourati S, De Prost N, Carteaux G, Brun-Buisson C, Bartolucci P, Habibi A, Mekontso Dessap A. Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease. Journal of Clinical Medicine. 2020; 9(11):3718. https://doi.org/10.3390/jcm9113718

Chicago/Turabian Style

Razazi, Keyvan; Gendreau, Ségolène; Cuquemelle, Elise; Khellaf, Mehdi; Guillaud, Constance; Godeau, Bertrand; Melica, Giovanna; Moutereau, Stéphane; Gomart, Camille; Fourati, Slim; De Prost, Nicolas; Carteaux, Guillaume; Brun-Buisson, Christian; Bartolucci, Pablo; Habibi, Anoosha; Mekontso Dessap, Armand. 2020. "Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease" J. Clin. Med. 9, no. 11: 3718. https://doi.org/10.3390/jcm9113718

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