the PROPAGE Study Gatan Gavazzi 1 , Mathieu Debray 2 , Benoit de - - PowerPoint PPT Presentation

Gaëtan Gavazzi1, Mathieu Debray2, Benoit de Wazieres3, Marc Paccalin4, Marc Bonnefoy5, Regis Gonthier6, S. Drevet1

1University Clinic of Geriatric Medicine, University of Grenoble-Alpes,

France 2Hospital of Annecy, 3University hospital of Nîmes, 4University hospital of Poitiers, 5University hospital of Lyon, 6University hospital of Saint Etienne, France

Procalcitonin to individualize Antibiotic duration in pneumonia very old population : the PROPAGE Study

CONFLICT OF INTEREST DISCLOSURE

Biomérieux Help to obtain PCT Assays

Infectious diseases and pneumonia are more difficult to diagnose Empiric ATBic therapy are often inappropriate (20-40%) Antibiotic consumption leads to Antibiotic resistance Decrease the global consumption of ATB per individual contribute to Individual and collective benefice =  numbers of prescription or  duration of ATbic

Schuetz P Cochrane data Syst Rev 2012, Stucker F JAGS 2005, Gavazzi G Lancet Inf Dis 2002, Antibiotique 2010

Background

PCT is reliable biomarkers to help to individualize ATB duration in different subsets of population and infection RTI duration 3.47 lower (3.78 to 3.17 lowerPneumonia/ Severe sepsis in ICU) PCT alogorithm and clinical judgment

No study specific to the very old population

= raising hospitalized population with numerous comorbidites and high risks of severe diseases.

Background

Schuetz P Cochrane data Syst Rev 2012, Stucker F JAGS 2005, Gavazzi G Antibiotique 2010

Are PCT serial measurements may reduces antibiotic duration in pneumonia (community

• r nosocomial) in patient older than 80 years

?

AIM of the STUDY

RANDOMIZED CLINICAL INTERVENTIONAL TRIAL 6 acute geriatric wards from different areas in France.

(Annecy, Grenoble, Poitiers, Nîmes, Lyon and Saint Etienne)

Inclusion criteria associated: > 80 years old, receiving ATbt <3 days for pneumonia, and had a PCT measurement. PCT was measured every 2 days in both groups

(from Day 2 to day 8 and at the end of treatment or at discharge)..

All characterisitcs Patients / pneumonia ( severity)

Methods

Registred in clinical trial NCT02173613

Results

Flow shart

Characteristics of patients / pneumonia

ADL : 68% between 4 to 6/6 at D-15, 52%,), IADL D-15 : 43% with IADL<3/8

similar in both groups

Characteristics of patients / pneumonia

similar in both groups

PCT LEVELS at admission and evolution p = 0.5

Rate of ATBIc duration

0% 20% 40% 60% 80% 100%

D2 D4 D6 D6 D8 D8 ATBic ic duration n ( days)

Contrôle PCT 91% 54% 72% 44%

Intention to treat : PCT group

• 8. 4 days (±3.1)

Control group 10.7 days( ±3.6)

P=0,001

Rate of ATBIc duration

Per protocol : PCT group

• 7. 2 days (±3.1)

Control group 10.7 days( ±3.6) Outcome day 45 and 90 No differences 89.5% of the control group 84% in the PCT group had a good outcome Algorithm follow up : 52%

PCT algorithm is useful to individualize the duration of ATBt for Hospitalized pneumonia even in very old and disable population. PCT < 0.25/ng/ l is the threshold without poorer outcome PCT dosage in between day 4 and 6 may stop ATBic in more than 60% of patients.

Discussion / Conclusion:

…….too less…. …..or too much

Thank you for your Attention

“The good physician treats the disease; the great physician treats the patient who has the disease.” William Osler