Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial.
Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial.
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DOI：
10.1186/cc7903
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Schroeder S
中科院分区：
文献类型：
--
作者：
Hochreiter M;Köhler T;Schweiger AM;Keck FS;Bein B;von Spiegel T;Schroeder S
细菌种属耐药性的发展是重新考虑抗生素治疗适应症和管理的一个紧迫问题。充分的适应症和治疗持续时间对于在重症监护环境中使用高效物质特别重要。直到最近，还没有实验室标记物可用于区分细菌感染与病毒或非感染性炎症反应;然而，在过去的几年中，降钙素原（PCT）是提供这种可能性的大量炎症变量中的第一个。本研究旨在调查PCT指导外科重症监护患者抗生素治疗的临床实用性。所有需要抗生素治疗的患者，根据确诊或高度怀疑的细菌感染和至少两个伴随全身炎症反应综合征标准，都有资格。患者被随机分配到PCT指导（研究组）或标准（对照组）抗生素方案。如果感染的临床体征和症状改善，PCT降至<1 ng/ml或PCT值>1 ng/ml，但在3天内降至初始值的25 - 35%，则停止PCT指导组的抗生素治疗。在对照组中，抗生素治疗作为标准方案应用超过8天。共有110名在确诊或高度疑似感染后接受抗生素治疗的外科重症监护患者入组本研究。在57例患者中，抗生素治疗由每日PCT和临床评估指导，并进行相应调整。对照组包括53名患者，标准化抗生素治疗持续时间超过8天。两组的人口统计学和临床数据相当。然而，PCT组的抗生素治疗持续时间显著短于对照组（5.9 +/- 1.7 vs 7.9 +/- 0.5天，P < 0.001），对临床结局无负面影响。PCT监测是指导外科重症监护患者抗生素治疗的有用工具。这可能有助于优化抗生素方案，对重症监护医学中的微生物耐药性和成本产生有益影响。结果先前以德语发表于Anaesthesist 2008; 57：571-577（PMID：18463831）。ISRCTN10288268
The development of resistance by bacterial species is a compelling issue to reconsider indications and administration of antibiotic treatment. Adequate indications and duration of therapy are particularly important for the use of highly potent substances in the intensive care setting. Until recently, no laboratory marker has been available to differentiate bacterial infection from viral or non-infectious inflammatory reaction; however, over the past years, procalcitonin (PCT) is the first among a large array of inflammatory variables that offers this possibility. The present study aimed to investigate the clinical usefulness of PCT for guiding antibiotic therapy in surgical intensive care patients. All patients requiring antibiotic therapy based on confirmed or highly suspected bacterial infections and at least two concomitant systemic inflammatory response syndrome criteria were eligible. Patients were randomly assigned to either a PCT-guided (study group) or a standard (control group) antibiotic regimen. Antibiotic therapy in the PCT-guided group was discontinued, if clinical signs and symptoms of infection improved and PCT decreased to <1 ng/ml or the PCT value was >1 ng/ml, but had dropped to 25 to 35% of the initial value over three days. In the control group antibiotic treatment was applied as standard regimen over eight days. A total of 110 surgical intensive care patients receiving antibiotic therapy after confirmed or high-grade suspected infections were enrolled in this study. In 57 patients antibiotic therapy was guided by daily PCT and clinical assessment and adjusted accordingly. The control group comprised 53 patients with a standardized duration of antibiotic therapy over eight days. Demographic and clinical data were comparable in both groups. However, in the PCT group the duration of antibiotic therapy was significantly shorter than compared to controls (5.9 +/- 1.7 versus 7.9 +/- 0.5 days, P < 0.001) without negative effects on clinical outcome. Monitoring of PCT is a helpful tool for guiding antibiotic treatment in surgical intensive care patients. This may contribute to an optimized antibiotic regimen with beneficial effects on microbial resistance and costs in intensive care medicine. Results were previously published in German in Anaesthesist 2008; 57: 571–577 (PMID: 18463831). ISRCTN10288268
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