Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf. Accessed February 2019.
Martens E, Demain AL. The antibiotic resistance crisis, with a focus on the United States. J Antibiot (Tokyo). 2017;70:520-526.
Centers for Disease Control and Prevention. About antimicrobial resistance. https://www.cdc.gov/drugresistance/about.html. Published September 2018. Accessed February 2019.
World Health Organization. Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. http://www.who.int/medicines/publications/WHO-PPL-Short_Summary_25Feb-ET_NM_WHO.pdf?ua=1. Published 2017. Accessed February 2019.
The White House. National action plan for combating antibiotic-resistant bacteria. https://www.cdc.gov/drugresistance/pdf/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Published March 2015. Accessed February 2019.
Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs. https://www.cdc.gov/antibiotic-use/healthcare/pdfs/core-elements.pdf. Published May 2015. Accessed February 2019.
Chapin KC. Unpublished data.
Reinhart K, Meisner M, Brunkhorst FM. Markers for sepsis diagnosis: what is useful? Crit Care Clin. 2006;22:503-519.
Long B, Koyfman A. Ready for prime time? Biomarkers in sepsis. Emerg Med Clin North Am. 2017;35:109-122.
Müller B, Becker KL, Schächinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000;28:977-983.
Brunkhorst FM, Heinz U, Forycki ZF. Kinetics of procalcitonin in iatrogenic sepsis. Intensive Care Med. 1998;24:888-892.
Harbarth S, Holeckova K, Froidevaux C, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med. 2001;164:396-402.
US Food and Drug Administration. Discussion and recommendations for the application of procalcitonin to the evaluation and management of suspected lower respiratory tract infections and sepsis. https://www.fda.gov/downloads/advisorycommittees/committeesmeetingmaterials/medicaldevices/medicaldevicesadvisorycommittee/microbiologydevicespanel/ucm528156.pdf. Published November 10, 2016. Accessed March 7, 2019.
Dipalo M, Guido L, Micca G, et al. Multicenter comparison of automated procalcitonin immunoassays. Pract Lab Med. 2015;2:22-28.
Schuetz P, Wirz Y, Sager R, et al. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. Lancet Infect Dis. 2018;18:95-107.
Schuetz P, Briel M, Christ-Crain M, et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient data meta-analysis. Clin Infect Dis. 2012;55:651-662.
Broyles MR. Impact of procalcitonin-guided antibiotic management on antibiotic exposure and outcomes: real-world evidence. Open Forum Infect Dis. 2017;4:ofx213.
Schuetz P, Beishuizen A, Broyles M, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use. Clin Chem Lab Med. 2019. doi: 10.1515/cclm-2018-1181. [Epub ahead of print].
Wirz Y, Meier MA, Bouadma L, et al. Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials. Crit Care. 2018;22:191.
Pepper D, Sun J, Rhee C, et al. Procalcitonin-guided antibiotic discontinuation and mortality in critically ill adults: a systematic review and meta-analysis. Chest. 2019. doi: 10.1016/j.chest.2018.12.029. [Epub ahead of print].
Meier MA, Branche A, Neeser OL, et al. Procalcitonin-guided antibiotic treatment in patients with positive blood cultures: a patient-level meta-analysis of randomized trials. Clin Infect Dis. 2018. doi: 10.1093/cid/ciy917. [Epub ahead of print].
Huang HB, Peng JM, Weng L, et al. Procalcitonin-guided antibiotic therapy in intensive care unit patients: a systematic review and meta-analysis. Ann Intensive Care. 2017;7:114.
Zhang T, Wang Y, Yang Q, et al. Procalcitonin-guided antibiotic therapy in critically ill adults: a meta-analysis. BMC Infect Dis. 2017;17:514.
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Moderator

Philipp Schuetz, MD, MPH

Professor of Medicine
University of Basel
Chief Physician
Department of General Internal Medicine and Emergency Medicine, Endocrinology, Diabetology and Metabolism
Kantonspital Aarau AG
Basel, Switzerland

Disclosures

Disclosure: Philipp Schuetz, MD, MPH, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: bioMérieux SA; Roche; Thermo Fisher Scientific Inc.
Served as a speaker or a member of a speakers bureau for: bioMérieux SA; Roche; Thermo Fisher Scientific Inc.

Faculty

Mike R. Broyles, PharmD

Director of Pharmacy and Laboratory Services
Five Rivers Medical Center
Pocahontas, Arkansas

Disclosures

Disclosure: Mike R. Broyles, PharmD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: bioMérieux SA; Fujirebio US, Inc.; Roche; Thermo Fisher Scientific Inc.
Served as a speaker or a member of a speakers bureau for: Abbott Laboratories; bioMérieux SA; Fujirebio US, Inc.; Roche; Thermo Fisher Scientific Inc.

Kimberle C. Chapin, MD

Professor of Pathology/Laboratory Medicine and Medicine
Brown University
Director of Microbiology Laboratory
Lifespan Academic Medical Center
Providence, Rhode Island

Disclosures

Disclosure: Kimberle C. Chapin, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Axcellerate Pharma LLC; GenMark Diagnostics, Inc.; Roche
Served as a speaker or a member of a speakers bureau for: Cepheid; GenMark Diagnostics, Inc.
Received grants for clinical research from: BioFire Diagnostics; Tangen Biosciences

Editor

Kalanethee Paul-Pletzer, PhD

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Kalanethee Paul-Pletzer, PhD, has disclosed no relevant financial relationships.

CE Reviewer

Amy Bernard, MS, BSN, RN-BC, CHCP

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, CHCP, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbott Laboratories; Medtronic, Inc.

CE

Stewardship in Focus: Taking a Closer Look at Procalcitonin-Guided Antibiotic De-Escalation

Authors: Philipp Schuetz, MD, MPH; Kimberle C. Chapin, MD; Mike R. Broyles, PharmD
CE Released: 4/15/2019
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 4/15/2021

Start Activity

Target Audience and Goal Statement

This activity is intended for pharmacists.

The goal of this activity is to improve clinicians' decision making regarding the initiation and duration of antibiotic therapy in patients presenting with infectious illnesses.

Upon completion of this activity, participants will:

Have increased knowledge regarding the strategies for antibiotic de-escalation
Have greater competence related to interpretation of biomarkers in the management of patients receiving antibiotic therapy
Have greater confidence regarding team-based approaches to antibiotic stewardship

Disclosures

Moderator

Philipp Schuetz, MD, MPH

Professor of Medicine
University of Basel
Chief Physician
Department of General Internal Medicine and Emergency Medicine, Endocrinology, Diabetology and Metabolism
Kantonspital Aarau AG
Basel, Switzerland

Disclosures

Disclosure: Philipp Schuetz, MD, MPH, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: bioMérieux SA; Roche; Thermo Fisher Scientific Inc.
Served as a speaker or a member of a speakers bureau for: bioMérieux SA; Roche; Thermo Fisher Scientific Inc.

Faculty

Mike R. Broyles, PharmD

Director of Pharmacy and Laboratory Services
Five Rivers Medical Center
Pocahontas, Arkansas

Disclosures

Disclosure: Mike R. Broyles, PharmD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: bioMérieux SA; Fujirebio US, Inc.; Roche; Thermo Fisher Scientific Inc.
Served as a speaker or a member of a speakers bureau for: Abbott Laboratories; bioMérieux SA; Fujirebio US, Inc.; Roche; Thermo Fisher Scientific Inc.

Kimberle C. Chapin, MD

Professor of Pathology/Laboratory Medicine and Medicine
Brown University
Director of Microbiology Laboratory
Lifespan Academic Medical Center
Providence, Rhode Island

Disclosures

Disclosure: Kimberle C. Chapin, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Axcellerate Pharma LLC; GenMark Diagnostics, Inc.; Roche
Served as a speaker or a member of a speakers bureau for: Cepheid; GenMark Diagnostics, Inc.
Received grants for clinical research from: BioFire Diagnostics; Tangen Biosciences

Editor

Kalanethee Paul-Pletzer, PhD

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Kalanethee Paul-Pletzer, PhD, has disclosed no relevant financial relationships.

CE Reviewer

Amy Bernard, MS, BSN, RN-BC, CHCP

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, CHCP, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbott Laboratories; Medtronic, Inc.

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For Pharmacists

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From Medscape Education Critical Care

Stewardship in Focus: Taking a Closer Look at Procalcitonin-Guided Antibiotic De-Escalation

Authors: Philipp Schuetz, MD, MPH; Kimberle C. Chapin, MD; Mike R. Broyles, PharmDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CE Released: 4/15/2019

Valid for credit through: 4/15/2021

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Educational Impact Challenge

The goal of this activity is to improve clinicians' decision making regarding the initiation and duration of antibiotic therapy in patients presenting with infectious illnesses.

Before you begin this activity, please assess your clinical knowledge by completing this brief survey. Answering these questions again after the activity will allow you to see what you learned and to compare your answers with those of your peers.

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The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may include therapeutic products that have not been approved by the US Food and Drug Administration, off-label uses of approved products, or data that were presented in abstract form. These data should be considered preliminary until published in a peer review journal. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity. A qualified healthcare professional should be consulted before using any therapeutic product discussed.

References

Faculty and Disclosures

Moderator

Philipp Schuetz, MD, MPH

Faculty

Mike R. Broyles, PharmD

Kimberle C. Chapin, MD

Editor

Kalanethee Paul-Pletzer, PhD

CE Reviewer

Amy Bernard, MS, BSN, RN-BC, CHCP

Peer Reviewer

CE

Stewardship in Focus: Taking a Closer Look at Procalcitonin-Guided Antibiotic De-Escalation

Target Audience and Goal Statement

Disclosures

Moderator

Philipp Schuetz, MD, MPH

Faculty

Mike R. Broyles, PharmD

Kimberle C. Chapin, MD

Editor

Kalanethee Paul-Pletzer, PhD

CE Reviewer

Amy Bernard, MS, BSN, RN-BC, CHCP

Peer Reviewer

Accreditation Statements

For Pharmacists

Instructions for Participation and Credit

Stewardship in Focus: Taking a Closer Look at Procalcitonin-Guided Antibiotic De-Escalation

Educational Impact Challenge