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 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