Acute Exacerbations of Chronic Obstructive Pulmonary Disease with a Low Procalcitonin: Impact of Antibiotic Therapy.

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Acute Exacerbations of Chronic Obstructive Pulmonary Disease with a Low Procalcitonin: Impact of Antibiotic Therapy.

Clin Infect Dis. 2018 Jul 02;:

Authors: Bremmer DN, Moffa MA, Ma K, Bean HR, Snatchko J, Trienski TL, Watson C, Walsh TL

Abstract
Background: Patients admitted with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) often are prescribed antibiotics. Studies have shown that the use of procalcitonin (PCT) to guide the decision to initiate antibiotic therapy in AECOPD has resulted in less antibiotic use and similar outcomes compared to standard of care. We evaluated patients with AECOPD and low PCT concentrations to determine whether antibiotic therapy was associated with improved outcomes.
Methods: We retrospectively evaluated adult patients admitted with AECOPD who had a peak PCT concentration <0.25µg/mL. Patients were evaluated based on their antibiotic exposure: ≤ 24 hours vs > 24 hours. We also evaluated outcomes based upon the duration of azithromycin therapy: ≤ 24 hours vs > 24 hours. The primary outcome was all-cause 30-day readmissions. Secondary outcomes included length of stay (LOS) and COPD-related 30-day readmissions.
Results: 161 and 195 patients received ≤ 24 hours vs > 24 hours of antibiotic therapy, respectively. The cohort with ≤ 24 hours of antibiotics had a shorter LOS (2.8 vs. 3.7 days; P=0.01). There was no differences in all-cause 30-day readmissions (15.5% vs. 17.4%; P=0.63) or COPD-related 30-day readmissions (11.2% vs. 12.3%; P=0.74). Additionally, patients receiving ≤ 24 hours of azithromycin had a shorter LOS (3.0 vs. 3.8 days; P=0.01) and there were no differences in all-cause 30-day readmissions (16.2% vs. 17.1%; P=0.82) or COPD-related 30-day readmissions (11.9% vs.11.6%; P=0.94).
Conclusions: For adult patients hospitalized with non-severe AECOPD and low PCT concentrations, antibiotic therapy beyond 24 hours did not improve outcomes.

PMID: 29982350 [PubMed - as supplied by publisher]

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