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Procalcitonin, mid-regional proadrenomedullin and C-reactive protein in predicting treatment outcome in community-acquired febrile urinary tract infection.


ABSTRACT: BACKGROUND:A reduction in duration of antibiotic therapy is crucial in minimizing the development of antimicrobial resistance, drug-related side effects and health care costs. The minimal effective duration of antimicrobial therapy for febrile urinary tract infections (fUTI) remains a topic of uncertainty, especially in male patients, those of older age or with comorbidities. Biomarkers have the potential to objectively identify the optimal moment for cessation of therapy. METHODS:A secondary analysis of a randomized placebo-controlled trial among 35 primary care centers and 7 emergency departments of regional hospitals in the Netherlands. Women and men aged ?18?years with a diagnosis of fUTI were randomly assigned to receive antibiotic treatment for 7 or 14?days. Patients indicated to receive antimicrobial treatment for more than 14?days were excluded from randomization. The biomarkers procalcitonin (PCT), mid-regional proadrenomedullin (MR-proADM), and C-reactive protein (CRP) were compared in their ability to predict clinical cure or failure through the 10-18?day post-treatment visit. RESULTS:Biomarker concentrations were measured in 249 patients, with a clinical cure rate of 94% in the 165 randomized and 88% in the 84 non-randomized patients. PCT, MR-proADM and CRP concentrations did not differ between patients with clinical cure and treatment failure, and did not predict treatment outcome, irrespective of 7 or 14?day treatment duration (ROCAUC 0.521; 0.515; 0.512, respectively). PCT concentrations at presentation were positively correlated with bacteraemia (? =?0.33, p 

SUBMITTER: Stalenhoef JE 

PROVIDER: S-EPMC6376649 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Procalcitonin, mid-regional proadrenomedullin and C-reactive protein in predicting treatment outcome in community-acquired febrile urinary tract infection.

Stalenhoef Janneke Evelyne JE   van Nieuwkoop Cees C   Wilson Darius Cameron DC   van der Starre Willize Elizabeth WE   van der Reijden Tanny J K TJK   Delfos Nathalie Manon NM   Leyten Eliane Madeleine Sophie EMS   Koster Ted T   Ablij Hans Christiaan HC   van 't Wout Johannes Jan Willem JJW   van Dissel Jaap Tamino JT  

BMC infectious diseases 20190214 1


<h4>Background</h4>A reduction in duration of antibiotic therapy is crucial in minimizing the development of antimicrobial resistance, drug-related side effects and health care costs. The minimal effective duration of antimicrobial therapy for febrile urinary tract infections (fUTI) remains a topic of uncertainty, especially in male patients, those of older age or with comorbidities. Biomarkers have the potential to objectively identify the optimal moment for cessation of therapy.<h4>Methods</h4  ...[more]

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