Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients*.
LAYIOS, Nathalie ; LAMBERMONT, Bernard ; CANIVET, Jean-Luc et al
in Critical Care Medicine (2012), 40(8), 2304-9
OBJECTIVES: : To test the usefulness of procalcitonin serum level for the reduction of antibiotic consumption in intensive care unit patients. DESIGN: : Single-center, prospective, randomized controlled ... [more ▼]
OBJECTIVES: : To test the usefulness of procalcitonin serum level for the reduction of antibiotic consumption in intensive care unit patients. DESIGN: : Single-center, prospective, randomized controlled study. SETTING: : Five intensive care units from a tertiary teaching hospital. PATIENTS: : All consecutive adult patients hospitalized for > 48 hrs in the intensive care unit during a 9-month period. INTERVENTIONS: : Procalcitonin serum level was obtained for all consecutive patients suspected of developing infection either on admission or during intensive care unit stay. The use of antibiotics was more or less strongly discouraged or recommended according to the Muller classification. Patients were randomized into two groups: one using the procalcitonin results (procalcitonin group) and one being blinded to the procalcitonin results (control group). The primary end point was the reduction of antibiotic use expressed as a proportion of treatment days and of daily defined dose per 100 intensive care unit days using a procalcitonin-guided approach. Secondary end points included: a posteriori assessment of the accuracy of the infectious diagnosis when using procalcitonin in the intensive care unit and of the diagnostic concordance between the intensive care unit physician and the infectious-disease specialist. MEASUREMENTS AND MAIN RESULTS: : There were 258 patients in the procalcitonin group and 251 patients in the control group. A significantly higher amount of withheld treatment was observed in the procalcitonin group of patients classified by the intensive care unit clinicians as having possible infection. This, however, did not result in a reduction of antibiotic consumption. The treatment days represented 62.6 +/- 34.4% and 57.7 +/- 34.4% of the intensive care unit stays in the procalcitonin and control groups, respectively (p = .11). According to the infectious-disease specialist, 33.8% of the cases in which no infection was confirmed, had a procalcitonin value >1microg/L and 14.9% of the cases with confirmed infection had procalcitonin levels <0.25 microg/L. The ability of procalcitonin to differentiate between certain or probable infection and possible or no infection, upon initiation of antibiotic treatment was low, as confirmed by the receiving operating curve analysis (area under the curve = 0.69). Finally, procalcitonin did not help improve concordance between the diagnostic confidence of the infectious-disease specialist and the ICU physician. CONCLUSIONS: : Procalcitonin measuring for the initiation of antimicrobials did not appear to be helpful in a strategy aiming at decreasing the antibiotic consumption in intensive care unit patients. [less ▲]Detailed reference viewed: 13 (2 ULg)
Les prélèvements microbiologiques ont-ils encore une place dans le diagnostic de pneumopathie acquise sous ventilation mécanique ?
LAYIOS, Nathalie ; DAMAS, Pierre
in Réanimation (2012), 21
Diagnosis of ventilator-associated pneumonia (VAP) is based on non-specific clinical signs. Several indicators have been tested in order to improve the accuracy of VAP diagnosis. The quantification of ... [more ▼]
Diagnosis of ventilator-associated pneumonia (VAP) is based on non-specific clinical signs. Several indicators have been tested in order to improve the accuracy of VAP diagnosis. The quantification of clinical parameters by using the clinical pulmonary infection score (CPIS), however, failed to improve the specificity of the diagnosis. This was the same for all the biomarkers tested either in the serum (procalcitonin, C-reactive protein) or in the bronchoalveolar lavage (BAL) fluid [soluble triggering receptor expressed on myeloid cells 1 (sTREM 1), elastin fibers, endotoxin, pro-inflammatory cytokines, Clara cell protein 10]. The microscopic examination of endotracheal samples alone, especially of the BAL fluid, may provide useful information for the detection of infected cells. Thus, microbiology is still needed. [less ▲]Detailed reference viewed: 19 (8 ULg)
Severity of ICU-acquired pneumonia according to infectious microorganisms
DAMAS, Pierre ; LAYIOS, Nathalie ; SEIDEL, Laurence et al
in Intensive Care Medicine (2011), 37(7), 1128-35Detailed reference viewed: 22 (5 ULg)
La décontamination digestive sélective: vieux démons ou .... jeune fiancée?
in Réanimation (2009), 18Detailed reference viewed: 7 (1 ULg)
Toxoplasma encephalitis after autologous stem cell transplantation.
; ; LAYIOS, Nathalie et al
in Leukemia & Lymphoma (2007), 48(1), 201-3Detailed reference viewed: 3 (0 ULg)
Relapsing T-cell lymphoma mimicking adult respiratory distress syndrome and sepsis.
; LAYIOS, Nathalie ; et al
in Leukemia & Lymphoma (2006), 47(9), 1989-90Detailed reference viewed: 4 (0 ULg)
High incidence of complications after 2-chloro-2'-deoxyadenosine combined with cyclophosphamide in patients with advanced lymphoproliferative malignancies.
; ; LAYIOS, Nathalie et al
in Annals of Hematology (2004), 83(6), 356-63
The combination of purine analogs with alkylating agents is able to produce a synergistic antitumoral effect. However, the addition of immunosuppressive and DNA-targeting agents might increase purine ... [more ▼]
The combination of purine analogs with alkylating agents is able to produce a synergistic antitumoral effect. However, the addition of immunosuppressive and DNA-targeting agents might increase purine analog-related complications. The risk for serious complications was evaluated in 38 patients treated with 2-chloro-2'-deoxyadenosine (CDA) and cyclophosphamide (CP). The diagnoses were chronic lymphocytic leukemia (CLL) in 15, Waldenstrom's macroglobulinemia in 4, mantle cell lymphoma in 6, follicular non-Hodgkin's lymphoma (NHL) in 10, and other low-grade NHL in 3 patients. All patients were pretreated (median: 2 lines, range: 1-5) and 23 (61%) were refractory. The patients received a median of two courses (range: 1-5) of 5.6 mg/m(2) CDA, followed by a median of 200 mg/m(2) CP, for 3 days. The response rate was 51% [complete remission (CR): 14%, partial remission (PR): 38%]. Grade 3/4 infections occurred in 16 (42%) patients. Dose-limiting cytopenias were seen in 22 (58%) patients. In 12 (32%) patients, autoimmune manifestations developed requiring treatment in most of them. Second cancers arose in five (13%) patients (myelodysplastic syndrome/acute myelocytic leukemia in three, lung cancer in two). Multivariate analysis showed that cytopenias, gender (F), prior radiotherapy, and age (>65 years) predicted for the complications seen after CDA-CP. To conclude, because of the high incidence of complications, caution is warranted in selecting patients with advanced lymphoid malignancies for the CDA-CP protocol. [less ▲]
Remission of severe cold agglutinin disease after Rituximab therapy.
LAYIOS, Nathalie ; ; et al
in Leukemia : Official Journal of the Leukemia Society of America, Leukemia Research Fund, U.K (2001), 15(1), 187-8Detailed reference viewed: 4 (0 ULg)