Pulmonary Embolism and PCT. PE-PCT Study
Pulmonary Embolism and PCT. PE-PCT Study
The clinical manifestations of pulmonary embolism vary greatly from the absence of specific
 clinical symptoms to cardiogenic shock or cardiac arrest. Clinical form of EP represented by
 "lung superinfection", also called "pulmonary embolism superinfected" is common and
 represents up to 30% of initial clinical presentations; she been few evaluations in clinical
 research. The reality of the bacterial infection remains controversial and the clinical
 presentation often leads to the prescription of empirical antibiotic therapy, often
 unnecessary in many cases. Number of antibiotic prescriptions are probably inappropriate.

 Fever has long been recognized as a sign associated with pulmonary embolism. Stein et al
 reported a temperature above 37.5 ° C on 50% of patients with acute pulmonary embolism
 without actually clarified whether this was related to temperature with a pulmonary embolism
 or other associated cause. Murray et al estimated that greater than 38 ° C was explained by
 pulmonary embolism in 57.1% of patients while in the PIOPED study, only 14% of patients had
 fever with no other cause identified as pulmonary embolism. Fever due to pulmonary embolism
 is often low intensity (often less than 38.3) and of short duration, with a peak on the day
 of pulmonary embolism and a gradual decrease of about 1 week. The pathophysiology of fever in
 pulmonary embolism has not yet was completely clarified. It is suggested that a combination
 of several factors involved pyrogenic myocardial tissue necrosis and releasing
 pro-inflammatory cytokines, hemorrhage, vascular irritation or inflammation, atelectasis or
 local superinfection.

 Since 2004, the PCT has become a marker helping the initiation of antibiotic therapy in
 patients with community-acquired pneumonia. This is especially verified in patients admitted
 for acute exacerbation of chronic obstructive bronchitis. In the latter case, the use of PCT
 reduces inappropriate antibiotic prescribing. Thus helping the clinician by measuring
 biomarkers such as PCT is based on writing an algorithm leading or not to use antibiotics.

 The use of an algorithm involving the PCT could just as for infectious pneumonia or COPD, of
 interest in the febrile pulmonary embolism to distinguish febrile forms related to bacterial
 infections febrile forms of EP to other causes.
The investigators propose to realize a single-center prospective, randomized, parallel group,
 to compare two groups of patients admitted with febrile pulmonary embolism . In the first
 group of patients, the use of antibiotics will be guided by clinical (clinical group). In the
 second group, the use of antibiotics will be guided by the algorithm (PCT group). The guided
 by the PCT algorithm is only given aid the clinician in the therapeutic management without
 its application only requires the doctor in charge of the patient. So if your doctor may
 advocate (or deemed necessary) to continue (or start) antibiotics even if the PCT algorithm
 would allow him to stop (or not initiate).
Inclusion Criteria:

 -  Age over 18 years

 -  CT diagnosis of pulmonary embolism

 -  Temperature> 37.8 ° C

 -  About affiliated to the social security

 -  Prior agreement with the patient signing a consent

 Exclusion Criteria:

 -  Pregnant Woman

 -  Refusal of the patient

 -  Pulmonary Neoplasia

 -  Antibiotic ongoing for more than 24 hours at the time of diagnosis of pulmonary
 embolism

 -  Cardiogenic shock (hypotension with mean arterial pressure less than 65 bpm)

 -  Suspicion of infection other than lung associated (associated urinary tract infection,
 prostatitis, ENT infection, sinusitis ...)

 -  Patient under guardianship

 -  Patients unable to give consent