Procalcitonin-guided antibiotic therapy for septic patients in the surgical intensive care unit.
Procalcitonin-guided antibiotic therapy for septic patients in the surgical intensive care unit.
复制标题
DOI：
10.1186/s40560-015-0100-9
复制
发表时间：
2015
影响因子：
7.1
通讯作者：
Carr JA
中科院分区：
文献类型：
--
作者：
Carr JA
在危重患者中，由于临床特征是相同的，因此阐明那些患有感染源（脓毒症）的全身炎症反应综合征（SIRS）的患者与那些患有无感染的SIRS的患者可能具有挑战性。即使有严格的监测和测试，39- 98%的SIRS患者将永远不会有感染的细菌学确认，6- 17%的有记录的感染患者将不会显示SIRS的迹象。由于这种重叠，已经进行了大量的研究，以研究与创伤、手术应激或其他非感染性原因引起的SIRS相比，确定和分离SIRS与感染的方法。这篇综述文章将讨论降钙素原在重症监护病房脓毒症患者中的推荐和同行批准使用，及其作为抗生素开始和终止的指南。本文将重点关注已进行的前瞻性随机试验（1级证据），并根据需要引用较低级别的证据来证实结论。文献记录了使用降钙素原作为节省成本和适当终止抗生素的指南的多种益处，其用作以前不可用的新的菌血症客观标志物。本文将表明，当降钙素原水平福尔斯0.5 ng/mL时，应终止抗生素治疗。
In critically ill patients, elucidating those patients with the systemic inflammatory response syndrome (SIRS) from an infectious source (sepsis), versus those who have SIRS without infection, can be challenging since the clinical features are the same. Even with strict monitoring and testing, 39–98 % of patients with SIRS will never have bacteriological confirmation of an infection, and 6–17 % of patients with a documented infection will not show signs of SIRS. Due to this overlap, an extensive amount of research has been performed to investigate ways of determining and separating SIRS from infection, compared to SIRS due to trauma, surgical stress, or other non-infectious causes. This review article will discuss the recommended and peer-approved use of procalcitonin in septic patients in the intensive care unit and its use as a guide to antibiotic initiation and termination. The article will focus on the prospective randomized trials (Level 1 evidence) that have been conducted, and lesser levels of evidence will be referenced as needed to substantiate a conclusion. The literature documents multiple benefits of using procalcitonin as a guide to cost savings and appropriate termination of antibiotics by its use as a new objective marker of bacteremia that was previously not available. This article will show that antibiotics should be terminated when the procalcitonin level falls below 0.5 ng/mL.