Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia a Randomized trial
Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia a Randomized trial
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DOI：
10.1164/rccm.200512-1922oc
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发表时间：
2006-07-01
影响因子：
24.7
通讯作者：
Mueller, Beat
中科院分区：
文献类型：
--
作者：
Christ-Crain, Miriam;Stolz, Daiana;Mueller, Beat
理由：对于社区获得性肺炎患者，指南推荐抗生素治疗7 - 21天。细菌感染时降钙素原升高，其动态变化具有预后意义。目的：评价降钙素原对社区获得性肺炎患者抗生素治疗起始和持续时间的指导作用。方法：在一项随机干预试验中，连续纳入302例疑似社区获得性肺炎患者。在基线、4、6和8 cl后以及6周后评估数据。对照组（151例）按常规给予抗生素治疗。在降钙素原组（n = 151）中，根据血清降钙素原浓度进行抗生素治疗：强烈建议低于0.1 μ g/L；劝阻，小于0.25 μ g/L；鼓励，大于0.25 μ g/L；建议大于0.5 μ g/L。主要终点是抗生素使用；次要终点是临床、实验室和放射学结果的测量。结果：在基线时，两组在临床、实验室和微生物学特征以及肺炎严重程度指数方面相似。与根据指南治疗的患者相比，降钙素原指导减少了总抗生素暴露（相对风险，0.52；95%可信区间，0.48-0.55;p < 0.001）、入院时的抗生素处方（85 vs. 99%; p < 0.001）和抗生素治疗持续时间（中位数，5 vs. 12 d; p < 0.001）。调整肺炎严重程度指数后，降钙素原组抗生素停药的风险比高于对照组（3.2；95%可信区间为2.5 ~ 4.2）。两组的结果相似，总成功率为83%。结论：降钙素原指导大大减少了社区获得性肺炎的抗生素使用。这些发现可能具有重要的临床和公共卫生意义。
Rationale: In patients with community-acquired pneumonia, guidelines recommend antibiotic treatment for 7 to 21 d. Procalcitonin is elevated in bacterial infections, and its dynamics have prognostic implications.Objective: To assess procalcitonin guidance for the initiation and duration of antibiotic therapy in community-acquired pneumonia.Methods: In a randomized intervention trial, 302 consecutive patients with suspected community-acquired pneumonia were included. Data were assessed at baseline, after 4, 6, and 8 cl, and after 6 wk. The control group (n = 151) received antibiotics according to usual practice. In the procalcitonin group (n = 151), antibiotic treatment was based on serum procalcitonin concentrations as follows: strongly discouraged, less than 0.1 mu g/L; discouraged, less than 0.25 mu g/L; encouraged, greater than 0.25 mu g/L; strongly encouraged, greater than 0.5 mu g/L. The primary endpoint was antibiotic use; secondary endpoints were measures of clinical, laboratory, and radiographic outcome.Results: At baseline, both groups were similar regarding clinical, laboratory, and microbiology characteristics, and Pneumonia Severity Index. Procalcitonin guidance reduced total antibiotic exposure (relative risk, 0.52; 95% confidence interval, 0.48-0.55; p < 0.001), antibiotic prescriptions on admission (85 vs. 99%; p < 0.001), and antibiotic treatment duration (median, 5 vs. 12 d; p < 0.001) compared with patients treated according to guidelines. After adjustment for Pneumonia Severity Index, the hazard ratio of antibiotic discontinuation was higher in the procalcitonin group than in the control group (3.2; 95% confidence interval, 2.5 to 4.2). Outcome was similar in both groups, with an overall success rate of 83%.Conclusions: Procalcitonin guidance substantially reduces antibiotic use in community-acquired pneumonia. These findings may have important clinical and public health implications.