{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T13:43:38Z","timestamp":1793108618344,"version":"4.5.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T00:00:00Z","timestamp":1724112000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Foreest Medical School"},{"name":"Pulmoscience"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In community-acquired pneumonia (CAP), the role of biomarkers to shorten duration of antibiotic treatment has not been firmly established. We assessed the effectiveness of active feedback of treatment algorithms based on procalcitonin (PCT) and C-reactive protein (CRP), compared to standard care, on the duration of antibiotic treatment in patients hospitalized with community-acquired pneumonia (CAP) in non-ICU wards.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>We performed a randomised, open label, parallel group, multi-centre trial in 3 Dutch teaching hospitals. Treatment was guided by a PCT algorithm, CRP algorithm or standard care. Participants were recruited by a member of the study team and randomised at day 2\u20133 of admission in a 1:1:1 ratio. Treatment was discontinued upon predefined thresholds of biomarkers that were assessed on admission, day 4 and days 5\u20137 if indicated. The primary outcome was total days on antibiotic treatment until day 30. In total 468 participants were included in this study. The median days on antibiotics (IQR) was 7 (IQR 7\u201310) in the control group, 4 (IQR 3\u20137) in the CRP group (rate ratio (RR) of 0.70, 95% CI 0.61\u20130.82 compared to standard care; p &lt;0.001), and 5.5 (IQR 3\u20139) in the PCT group (RR of 0.78, 95% CI 0.68\u20130.89 compared to standard care; p &lt;0.001). New antibiotics within the first 30 days were prescribed to 24, 23 and 35 patients in standard care, CRP and PCT groups, respectively. The hazard ratio for a new prescription in patients in the PCT group compared to standard care 1.63 (CI 0.97\u20132.75; p = 0.06). No difference in time to clinical stability or length of stay was found.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A strategy of feedback of CRP-guided and PCT-guided treatment algorithms reduced the number of days on antibiotic in the first 30 days after hospital admission in non-ICU wards for CAP. The study was not powered to determine safety of shortening duration of antibiotic treatment. (NCT01964495).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0307193","type":"journal-article","created":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T13:44:40Z","timestamp":1724161480000},"page":"e0307193","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Biomarker guided antibiotic stewardship in community acquired pneumonia: A randomized controlled trial"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1376-781X","authenticated-orcid":true,"given":"Ruud","family":"Duijkers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrik J.","family":"Prins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn","family":"Kross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Snijders","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan W. K.","family":"van den Berg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwendolyn M.","family":"Werkman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nynke","family":"van der Veen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Schoorl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc J. M.","family":"Bonten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis H.","family":"van Werkhoven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wim G.","family":"Boersma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,20]]},"reference":[{"key":"pone.0307193.ref001","unstructured":"World Health Organization. World health statistics 2015. https:\/\/iris.who.int\/handle\/10665\/170250."},{"key":"pone.0307193.ref002","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1136\/thx.2009.129502","article-title":"Clinical and economic burden of community-acquired pneumonia among adults in Europe","volume":"67","author":"T Welte","year":"2012","journal-title":"Thorax"},{"key":"pone.0307193.ref003","unstructured":"European Respiratory Society\/European Lung Foundation. Pneumonia. European lung white book. 2013: Chapter 1,2 and 18. https:\/\/www.ersnet.org\/the-european-lung-white-book\/"},{"key":"pone.0307193.ref004","article-title":"British Thoracic Society community acquired pneumonia guideline and the NICE pneumonia guideline: how they fit together","volume":"2","author":"WS Lim","year":"2015","journal-title":"BMJ Open Respir Res"},{"key":"pone.0307193.ref005","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America","volume":"200","author":"JP Metlay","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0307193.ref006","first-page":"4","article-title":"Management of community-acquired pneumonia in adults: 2016 guideline update from the Dutch Working Party on Antibiotic Policy (SWAB) and Dutch Association of Chest Physicians (NVALT)","volume":"76","author":"WJ Wiersinga","year":"2018","journal-title":"Neth J Med"},{"key":"pone.0307193.ref007","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1001\/jamainternmed.2016.3633","article-title":"Duration of Antibiotic Treatment in Community-Acquired Pneumonia: A Multicenter Randomized Clinical Trial","volume":"176","author":"A Uranga","year":"2016","journal-title":"JAMA Intern Med"},{"key":"pone.0307193.ref008","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/QCO.0000000000000140","article-title":"How to choose the duration of antibiotic therapy in patients with pneumonia","volume":"28","author":"DURATION Study Group","year":"2015","journal-title":"Curr Opin Infect Dis"},{"key":"pone.0307193.ref009","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/S0140-6736(04)15591-8","article-title":"Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial","volume":"363","author":"M Christ-Crain","year":"2004","journal-title":"Lancet"},{"key":"pone.0307193.ref010","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/S1473-3099(21)00255-3","article-title":"Narrow-spectrum antibiotics for community-acquired pneumonia in Dutch adults (CAP-PACT): a cross-sectional, stepped-wedge, cluster-randomised, non-inferiority, antimicrobial stewardship intervention trial","volume":"22","author":"CAP-PACT Study Group","year":"2022","journal-title":"Lancet Infect Dis"},{"key":"pone.0307193.ref011","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/S1473-3099(17)30592-3","article-title":"Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis","volume":"18","author":"P Schuetz","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"pone.0307193.ref012","first-page":"CD007498","article-title":"Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections","volume":"10","author":"P Schuetz","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0307193.ref013","doi-asserted-by":"crossref","first-page":"208","DOI":"10.21037\/atm.2017.04.04","article-title":"Biomarker-guided antibiotic therapy-strengths and limitations","volume":"5","author":"D Nora","year":"2017","journal-title":"Ann Transl Med"},{"key":"pone.0307193.ref014","article-title":"Inflammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP: results from the German competence network CAPNETZ","volume":"10","author":"CAPNETZ Study Group","year":"2009","journal-title":"Respir Res"},{"key":"pone.0307193.ref015","doi-asserted-by":"crossref","DOI":"10.1186\/2110-5820-2-32","article-title":"Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review","volume":"2","author":"P Povoa","year":"2012","journal-title":"Ann Intensive Care"},{"key":"pone.0307193.ref016","doi-asserted-by":"crossref","first-page":"R53","DOI":"10.1186\/cc11291","article-title":"Patterns of c-reactive protein RATIO response in severe community-acquired pneumonia: a cohort study","volume":"16","author":"LM Coelho","year":"2012","journal-title":"Crit Care"},{"key":"pone.0307193.ref017","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1164\/rccm.200905-0808OC","article-title":"Efficacy of corticosteroids in community-acquired pneumonia: a randomized double-blinded clinical trial","volume":"181","author":"D Snijders","year":"2010","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0307193.ref018","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1164\/rccm.200512-1922OC","article-title":"Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial","volume":"174","author":"M Christ-Crain","year":"2006","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0307193.ref019","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1016\/S0140-6736(21)00313-5","article-title":"Discontinuing beta-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial","volume":"397","author":"Pneumonia Short Treatment (PTC) Study Group","year":"2021","journal-title":"Lancet"},{"key":"pone.0307193.ref020","doi-asserted-by":"crossref","first-page":"336","DOI":"10.12788\/jhm.2905","article-title":"Shorter Versus Longer Courses of Antibiotics for Infection in Hospitalized Patients: A Systematic Review and Meta-Analysis","volume":"13","author":"S Royer","year":"2018","journal-title":"J Hosp Med"},{"key":"pone.0307193.ref021","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1002\/phar.2118","article-title":"Shortened Courses of Antibiotics for Bacterial Infections: A Systematic Review of Randomized Controlled Trials","volume":"38","author":"AM Hanretty","year":"2018","journal-title":"Pharmacotherapy"},{"key":"pone.0307193.ref022","first-page":"n2894","article-title":"Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents: cluster randomised controlled trial","volume":"375","author":"TM Boere","year":"2021","journal-title":"BMJ"},{"key":"pone.0307193.ref023","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1080\/23744235.2016.1253860","article-title":"Failure of CRP decline within three days of hospitalization is associated with poor prognosis of Community-acquired Pneumonia","volume":"49","author":"SB Andersen","year":"2017","journal-title":"Infect Dis (Lond)"},{"key":"pone.0307193.ref024","doi-asserted-by":"crossref","first-page":"2336","DOI":"10.1097\/CCM.0b013e31828e969f","article-title":"Procalcitonin versus C-reactive protein for guiding antibiotic therapy in sepsis: a randomized trial","volume":"41","author":"CF Oliveira","year":"2013","journal-title":"Crit Care Med"},{"key":"pone.0307193.ref025","doi-asserted-by":"crossref","DOI":"10.1186\/s13054-020-02946-y","article-title":"Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers","volume":"24","author":"I Borges","year":"2020","journal-title":"Crit Care"},{"key":"pone.0307193.ref026","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.ijid.2019.05.034","article-title":"Ineffectiveness of procalcitonin-guided antibiotic therapy in severely critically ill patients: A meta-analysis","volume":"85","author":"F Peng","year":"2019","journal-title":"Int J Infect Dis"},{"key":"pone.0307193.ref027","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1007\/s00134-015-3978-8","article-title":"Pros and cons of using biomarkers versus clinical decisions in start and stop decisions for antibiotics in the critical care setting","volume":"41","author":"WC Albrich","year":"2015","journal-title":"Intensive Care Med"},{"key":"pone.0307193.ref028","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1515\/cclm-2020-0198","article-title":"Laboratory abnormalities in patients with COVID-2019 infection","volume":"58","author":"G Lippi","year":"2020","journal-title":"Clin Chem Lab Med"},{"key":"pone.0307193.ref029","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.cmi.2019.08.017","article-title":"Optimizing design of research to evaluate antibiotic stewardship interventions: consensus recommendations of a multinational working group","volume":"26","author":"Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) Working Group on Design of Antimicrobial Stewardship Evaluations","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"pone.0307193.ref030","doi-asserted-by":"crossref","first-page":"153","DOI":"10.7326\/M18-3640","article-title":"Excess Antibiotic Treatment Duration and Adverse Events in Patients Hospitalized With Pneumonia: A Multihospital Cohort Study","volume":"171","author":"VM Vaughn","year":"2019","journal-title":"Ann Intern Med"}],"container-title":["PLOS 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