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Procalcitonin-based algorithm (ALGOPRO) for antibiotic and hospitalization decisions in adult patients with fever in the emergency department: a pilot study Volume 14, issue 1, Janvier-Février 2024

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Authors
1 Service d’accueil des urgences, hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75020 Paris, France
2 Service d’accueil des urgences, hôpital Pitié-Salpêtrière, AP-HP, F-75013 Paris, France
3 Centre hospitalier de Millau, F-12101 Millau, France
4 Coordination Hospitalisation à domicile (HAD), CHU de Nantes, F-44000 Nantes, France
5 Sorbonne Université, UMRS Inserm 1166, IHU ICAN, et service d’accueil des urgences, hôpital Pitié-Salpêtrière, AP-HP, F-75013 Paris, France
6 Fédération de biochimie, hôpital Pitié-Salpêtrière, AP-HP, F-75013 Paris, France
7 Sorbonne Université, GRC-14 BIOSFAST, CIMI UMR INSERM 1135, F-75013 Paris France
* Correspondance : P. Hausfater

Introduction

Procalcitonin is a biomarker used for the suspicions of lower respiratory tract infections. The aim of this study was to validate the safety of a procalcitonin-based algorithm for antibiotic therapy and hospitalisation decisions in patients presenting to the ED with fever.

Methods

Prospective open-label interventional pilot study in adult patients presenting to the ED with a temperature ≥38°C. We used an algorithm to decide on antibiotic therapy and admission, taking into account the following variables: immunosuppression, existing infectious site, severe sepsis and procalcitonin value. The primary outcome was an adverse event (AE), defined as an erroneous abstention (hospitalisation for the same infectious episode during follow-up or justified secondary prescription of antibiotics within 7 days of ED visit). The secondary endpoint was a serious adverse event (SAE: death or ICU admission within 30 days). An AE rate of

Results

Out of 210 patients included for analysis, 137 decisions to withhold antibiotics and hospital admission were made. Using the algorithm resulted in 0 SAEs (CI95 % 0 to 2.7 %) and 8 AEs (5.8 %, CI95 % 1.9 to 10.0 %).

Conclusion

An algorithm taking into account clinical data and procalcitonin levels for adult patients presenting with fever in ED may improve the rational use of antibiotics in ED.