Antibiotic Guidance in Acute Heart Failure (AHF)

Application of B·R·A·H·M·S PCT-guided algorithm could improve outcome

B·R·A·H·M·S PCT (Procalcitonin) level >0.25 μg/L is indicative of infection and antibiotic treatment is recommended in patients with dyspnea

Secondary analysis of 233 patients with a history of Chronic Heart Failure (CHF), formerly included in a multicenter randomized-controlled trial, to compare antibiotic guidance with and without PCT algorithm. In 110 patients with low initial PCT value (<0.25 μg/L)

  • 30 day adverse outcome was significantly decreased (-16%) in PCT-guided group
  • Significant reduction of antibiotic exposure in PCT-guided group (-2.8 days)

Time to the first adverse outcome by randomization group in patients with low initial PCT levels (<0.25 μg/L); adverse outcome included all-cause mortality or ICU admission Time to the first adverse outcome by randomization group in patients with low initial PCT levels (<0.25 μg/L); adverse outcome included all-cause mortality or intensive care unit (ICU) admission Ref-1

 

B·R·A·H·M·S PCT (Procalcitonin) can quickly identify Heart Failure (HF) patients who might benefit from antibiotics

Results of the BACH trial

Prospective, observational, international trial; 1641 patients with dyspnea presenting to Emergency Department (ED); patient outcomes assessed at 90 days Ref-2

  • PCT was the most accurate individual clinical variable in the diagnosis of pneumonia (AUC 72.3%)
  • Combining physician estimates of the probability of pneumonia with PCT values increased the accuracy of pneumonia diagnosis to >86%
  • AHF patients with elevated PCT level (>0.21 μg/L) had a worse outcome if not treated with antibiotics (Figure A)
  • AHF patients with low PCT level (<0.05 g μg/L) had a better outcome if they did not receive antibiotic therapy (Figure C)

 

Survival and antibiotic treatment of Heart Failure patients with different PCT levels

References Antibiotic Guidance in Acute Heart Failure (AHF)

Ref-1: Schuetz et al., Int J Cardiol 2014; 175: 464-72

Ref-2: Maisel et al., Eur J Heart Fail 2012; 14: 278-86

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