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Procalcitonin-guided antibiotic therapy in acute exacerbations of chronic bronchitis –The ProCOLD Study

Pneumology, University Hospital Basel, Basel, Switzerland

PURPOSE: Antibiotics are widely prescribed in acute exacerbation of chronic bronchitis (AECB), although a limited benefit of antibiotic therapy could only be shown in severe exacerbations (type 1), according to the Anthonisens criteria. Procalcitonin (ProCT) is a surrogate marker for clinical relevant bacterial infections. This study aimed to evaluate the outcome of AECB comparing a standard with a PCT-guided antibiotic approach.

METHODS: 80 patients presenting with AECB were included in this prospective, controlled, randomized, single-center trial. In the ProCT-group, antibiotic therapy was discouraged (ProCT < 0.1 ng/ml) or encouraged (ProCT > 0.25 ng/ml) based on ProCT levels using a new, sensitive assay (Kryptor PCT, B.R.A.H.M.S.). A standardized work-up, including C-reactive protein, leukocyte counts, sputum/BAL bacteriology, viral serology, blood cultures, spirometry, chest X-ray and clinical parameters was performed.

RESULTS: Baseline characteristics, including exacerbation and hospitalization rate in the preceding year, duration of the AECB and COPD, long-term therapy, pretreatment with antibiotics, laboratory parameters as well as quality of life, were similar in both groups. Mean age was 70,9 years and mean FEV1 was 0.97 SD 0.46 L (42%) on admission. 48/80 (60%)patients presented with a type 1 exacerbation. According to the GOLD criteria, COPD was severe or very severe in 75% of all patients. Sputum cultures were positive in 29/48 (60,4%) cases. Median procalcitonin levels were 0.084 SD 0.34 ng/ml - in 45 (56%) patients < 0.1ng/ml; 21 (26%) patients 0.1-0.25 ng/ml and 14 (17.5%) patients > 0.25ng/ml. Results: There was no difference in outcome between both groups (hospitalization length, ICU stay, mortality, improvement in FEV1, quality of life). AECB were treated with antibiotics in 17/40 (42,5%) cases in the PCT-guided group in comparison to 29/40 (72,5%) cases in the standard group (p=0.012).

CONCLUSION: A procalcitonin guided approach allowed a 42% reduction of antibiotic prescription for AECB with a similar clinical and laboratory outcome.

CLINICAL IMPLICATIONS: Antibiotic use can significantly and safely be reduced in AECB using procalcitonin as a marker for bacterial infection.

DISCLOSURE: D. Stolz, None.