Procalcitonin-based Algorithm (ALGOPRO) for Antibiotic and Hospitalization Decisions in Adult Patients with Fever in the Emergency Department: a Pilot Study

Introduction: Procalcitonin is a biomarker used for the suspicions of lower respiratory tract infections. The aim of this study was to validate the safety of a procalcitonin-based algorithm for antibiotic therapy and hospitalisation decisions in patients presenting to the ED with fever. Methods: Prospective open -label interventional pilot study in adult patients presenting to the ED with a temperature >= 38 degrees C. We used an algorithm to decide on antibiotic therapy and admission, taking into account the following variables: immunosuppression, existing infectious site, severe sepsis and procalcitonin value. The primary outcome was an adverse event (AE), defined as an erroneous abstention (hospitalisation for the same infectious episode during follow-up or justified secondary prescription of antibiotics within 7 days of ED visit). The secondary endpoint was a serious adverse event (SAE: death or ICU admission within 30 days). An AE rate of <5 % was considered necessary to validate the safety of the algorithm. Results: Out of 210 patients included for analysis, 137 decisions to withhold antibiotics and hospital admission were made. Using the algorithm resulted in 0 SAEs (CI95 % 0 to 2.7 %) and 8 AEs (5.8 %, CI95 % 1.9 to 10.0 %). Conclusion: An algorithm taking into account clinical data and procalcitonin levels for adult patients presenting with fever in ED may improve the rational use of antibiotics in ED.