Excerpt

Sepsis is a serious condition with high morbidity and mortality for which clinical diagnostic criteria lack sensitivity and specificity. Early initiation of appropriate antibiotics and goal-directed therapies reduce mortality. Conversely, overuse and misuse of antibiotics, including continuing antibiotics longer than necessary for cure can result in adverse events and add to the increasing problem of antibiotic resistance.

Several serum biomarkers have been identified in recent years that have the potential to help diagnose local and systemic infections, differentiate bacterial and fungal infections from viral syndromes or noninfectious conditions, prognosticate, and ultimately guide management, particularly antibiotic therapy. Among these, procalcitonin is the most extensively studied biomarker. Numerous studies have investigated the potential roles of procalcitonin in diagnosing and managing local and systemic infections. However, its clinical utility in the diagnosis and management of patients with suspected infections remains unclear.

Contents

• Preface
• Acknowledgments
• Executive Summary
• Introduction
  • Background
• Methods
  • Identification of Research Needs
  • Literature Search Update
  • Criteria for Prioritization
  • Methods for Ranking Research Needs
  • Engagement of Stakeholders, Researchers, Funders
  • Research Question Development and Study Design Considerations
• Results
  • Research Needs
  • Research Questions
  • Study Design Considerations
• Discussion
• Conclusion
• References
• Acronyms and Abbreviations
• Appendix A Summary of Evidence From Draft Comparative Effectiveness Review
• Appendix B Search Strategy for Ongoing Studies
• Appendix C Survey Tool Used To Rate Research Needs
• Appendix D Survey Tool Used To Rate Research Questions
• Appendix E List of Research Needs
• Appendix F Survey Results of Research Needs
• Appendix G Survey Results of Research Questions

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services¹, Contract No. 290-2007-10058-I. Prepared by: Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center, Chicago, IL

Suggested citation:

Noorani HZ, Adams E, Pitrak D, Belinson S, Aronson N. Future Research Needs on Procalcitonin-Guided Antibiotic Therapy. Future Research Needs Paper No. 29. (Prepared by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. 290-2007-10058-I.) AHRQ Publication No. 13-EHC034-EF. Rockville, MD: Agency for Healthcare Research and Quality. January 2013. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10058-I). The findings and conclusions in this document are those of the author(s), who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help health care researchers and funders of research make well-informed decisions in designing and funding research and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of scientific judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical research and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances.

None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

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