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BMC Medicine
Published in: BMC Medicine 1/2015

Open Access 01-12-2015 | Research article

Procalcitonin and pyuria-based algorithm reduces antibiotic use in urinary tract infections: a randomized controlled trial

Authors: Daniel Drozdov, Stefanie Schwarz, Alexander Kutz, Eva Grolimund, Anna Christina Rast, Deborah Steiner, Katharina Regez, Ursula Schild, Merih Guglielmetti, Antoinette Conca, Barbara Reutlinger, Cornelia Ottiger, Florian Buchkremer, Sebastian Haubitz, Claudine Blum, Andreas Huber, Ulrich Buergi, Philipp Schuetz, Andreas Bock, Christoph Andreas Fux, Beat Mueller, Werner Christian Albrich

Published in: BMC Medicine | Issue 1/2015

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Abstract

Background

Urinary tract infections (UTIs) are common drivers of antibiotic use. The minimal effective duration of antibiotic therapy for UTIs is unknown, but any reduction is important to diminish selection pressure for antibiotic resistance, costs, and drug-related side-effects. The aim of this study was to investigate whether an algorithm based on procalcitonin (PCT) and quantitative pyuria reduces antibiotic exposure.

Methods

From April 2012 to March 2014, we conducted a factorial design randomized controlled open-label trial. Immunocompetent adults with community-acquired non-catheter-related UTI were enrolled in the emergency department of a tertiary-care 600-bed hospital in northwestern Switzerland. Clinical presentation was used to guide initiation and duration of antibiotic therapy according to current guidelines (control group) or with a PCT-pyuria-based algorithm (PCT-pyuria group).
The primary endpoint was overall antibiotic exposure within 90 days. Secondary endpoints included duration of the initial antibiotic therapy, persistent infection 7 days after end of therapy and 30 days after enrollment, recurrence and rehospitalizations within 90 days.

Results

Overall, 394 patients were screened, 228 met predefined exclusion criteria, 30 declined to participate, and 11 were not eligible. Of these, 125 (76% women) were enrolled in the intention-to-treat (ITT) analysis and 96 patients with microbiologically confirmed UTI constituted the per protocol group; 84 of 125 (67%) patients had a febrile UTI, 28 (22%) had bacteremia, 5 (4%) died, and 3 (2%) were lost to follow-up. Overall antibiotic exposure within 90 days was shorter in the PCT-pyuria group than in the control group (median 7.0 [IQR, 5.0–14.0] vs. 10.0 [IQR, 7.0–16.0] days, P = 0.011) in the ITT analysis. Mortality, rates of persistent infections, recurrences, and rehospitalizations were not different.

Conclusions

A PCT-pyuria-based algorithm reduced antibiotic exposure by 30% when compared to current guidelines without apparent negative effects on clinical outcomes.

Trial registration

Current controlled trials ISRCTN13663741, date applied: 22/05/2012, date assigned: 03/07/2012, last edited: 28/01/2014.
Appendix
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Metadata
Title
Procalcitonin and pyuria-based algorithm reduces antibiotic use in urinary tract infections: a randomized controlled trial
Authors
Daniel Drozdov
Stefanie Schwarz
Alexander Kutz
Eva Grolimund
Anna Christina Rast
Deborah Steiner
Katharina Regez
Ursula Schild
Merih Guglielmetti
Antoinette Conca
Barbara Reutlinger
Cornelia Ottiger
Florian Buchkremer
Sebastian Haubitz
Claudine Blum
Andreas Huber
Ulrich Buergi
Philipp Schuetz
Andreas Bock
Christoph Andreas Fux
Beat Mueller
Werner Christian Albrich
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2015
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-015-0347-y

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