Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study
Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study
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DOI：
10.1007/s00423-008-0432-1
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发表时间：
2009-03-01
影响因子：
2.3
通讯作者：
von Spiegel, T.
中科院分区：
文献类型：
--
作者：
Schroeder, S.;Hochreiter, M.;von Spiegel, T.
适当的适应症和给药持续时间是重症监护医学中现代抗生素治疗的中心问题。已知生化变量降钙素原（PCT）可高度准确地指示全身相关细菌感染。在本研究中，我们的目的是调查PCT指导严重脓毒症外科重症监护患者抗生素治疗的临床实用性。患者被随机分配到PCT指导或对照组，需要抗生素治疗。所有患者均根据假定的微生物谱接受计算的抗生素方案。在PCT指导组中，如果感染的临床体征改善，并且PCT值< 1 ng/ml或在连续3天内降至初始浓度的35%，则停止抗生素治疗。在对照组中，抗生素治疗由经验规则指导，PCT指导组（n = 14例患者）和对照组（n = 13例患者）在生物学变量、基础疾病和总体疾病严重程度方面没有差异。PCT指导导致抗生素治疗从6.6 +/- 1.1天显著减少（平均值+/- SD），对照患者为8.3 +/- 0.7天（p < 0.001）沿着抗生素治疗费用降低17.8% PCT监测是指导外科重症监护患者严重脓毒症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具有有益影响。
Adequate indication and duration of administration are central issues of modern antibiotic treatment in intensive care medicine. The biochemical variable procalcitonin (PCT) is known to indicate systemically relevant bacterial infections with high accuracy. In the present study, we aimed to investigate the clinical usefulness of PCT for guiding antibiotic treatment in surgical intensive care patients with severe sepsis.Patients were randomly assigned to a PCT-guided or a control group requiring antibiotic treatment. All patients received a calculated antibiotic regimen according to the presumed microbiological spectrum. In the PCT-guided group, antibiotic treatment was discontinued if clinical signs of infection improved and the PCT value was either < 1 ng/ml or decreased to < 35% of the initial concentration within three consecutive days. In the control group, antibiotic treatment was directed by empirical rules.The PCT-guided group (n = 14 patients) and the control group (n = 13 patients) did not differ in terms of biological variables, underlying diseases, and overall disease severity. PCT guidance led to a significant reduction of antibiotic treatment from 6.6 +/- 1.1 days (mean +/- SD) compared with 8.3 +/- 0.7 days in control patients (p < 0.001) along with a reduction of antibiotic treatment costs of 17.8% (p < 0.01) without any adverse effects on outcome.Monitoring of PCT is a helpful tool for guiding antibiotic treatment in surgical intensive care patients with severe sepsis. This may contribute to an optimized antibiotic regimen with beneficial effects on microbial resistances and costs in intensive care medicine.