The Comparison of Procalcitonin Guidance Administer Antibiotics with Empiric Antibiotic Therapy in Critically Ill Patients Admitted in Intensive Care Unit
-
Atabak Najafi
,
Ali Khodadadian
,
Mehdi Sanatkar
,
Reza Shariat Moharari
,
Farhad Etezadi
,
Arezoo Ahmadi
,
Farsad Imani
,
Mohammad Reza Khajavi
Abstract
The empiric antibiotic therapy can result in antibiotic overuse, development of bacterial resistance and increasing costs in critically ill patients. The aim of the present study was to evaluate the effect of procalcitonin (PCT) guide treatment on antibiotic use and clinical outcomes of patients admitted to intensive care unit (ICU) with systemic inflammatory response syndrome (SIRS). A total of 60 patients were enrolled in this study and randomly divided into two groups, cases that underwent antibiotic treatment based on serum level of PCT as PCT group (n=30) and patients who undergoing antibiotic empiric therapy as control group (n=30). Our primary endpoint was the use of antibiotic treatment. Additional endpoints were changed in clinical status and early mortality. Antibiotics use was lower in PCT group compared to control group (P=0.03). Current data showed that difference in SOFA score from the first day to the second day after admitting patients in ICU did not significantly differ (P=0.88). Patients in PCT group had a significantly shorter median ICU stay, four days versus six days (P=0.01). However, hospital stay was not statistically significant different between two groups, 20 days versus 22 days (P=0.23). Early mortality was similar between two groups. PCT guidance administers antibiotics reduce antibiotics exposure and length of ICU stay, and we found no differences in clinical outcomes and early mortality rates between the two studied groups.
Calandra T, Cohen J. International Sepsis Forumn Definition of Infection in the ICU Consensus Conference. Crit Care Med 2005;33(7):1538-48.
Evans HL, Lefrak SN, Lyman J, et al. Cost of Gramnegative resistance. Crit Care Med 2007;35(1):89-95.
Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsisn and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. 1992. Chest 2009;136(5 Suppl):e28.
Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for the management of severe sepsis and septic shock: 2008. Intensive Care Med 2008;34(1):17-60.
Harbarth S, Garbino J, Pugin J, et al. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med 2003;115(7):529-35.
Bergmans DC, Bonten MJ, Gaillard CA, et al. Indications for antibiotic use in ICU patients: a one-year prospective surveillance. J Antimicrob Chemother 199;39(4):527-35.
Brunkhorst FM, Wegscheider K, Forycki ZF, et al. Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock. Intensive Care Med 2000;26(Suppl 2): S148-52.
Uzzan B, Cohen R, Nicolas P, et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med 2006;34(7):1996-2003.
Reinhart K, Meisner M, Brunkhorst FM. Markers for sepsis diagnosis: what is useful? Crit Care Clin2006;22(3):503-19.
Meynaar IA, Droog W, Batstra M, et al. In Critically Ill Patients, Serum Procalcitonin Is More Useful in Differentiating between Sepsis and SIRS than CRP, Il-6, or LBP. Crit Care Res Pract 2011;2011:594645.
Müller F, Christ-Crain M, Bregenzer T, et al. Procalcitonin levels predict bacteremia in patients with communityacquired pneumonia: a prospective cohort trial. Chest 2010;138(1):121-9.
Christ-Crain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006;174(1):84-93.
Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: clusterrandomised, single-blinded intervention trial. Lancet 2004;363(9409):600-7.
Müller B, Becker KL, Schächinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000;28(4):977-83.
Harbarth S, Nobre V, Pittet D. Does antibiotic selection impact patient outcome? Clin Infect Dis 2007;44(1):87-93.
Harbarth S. Nosocomial transmission of antibiotic-resistant microorganisms. Curr Opin Infect Dis 2001;14(4):437-42.
Reinhart K, Meisner M, Brunkhorst FM. Markers for sepsis diagnosis: what is useful? Crit Care Clin 2006;22(3):503-19.
Simon L, Gauvin F, Amre DK, et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004;39(2):206-17.
Uzzan B, Cohen R, Nicolas P, et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med 2006;34(7):1996-2003.
Li H, Luo YF, Blackwell TS, et al. Meta-analysis and systematic review of procalcitonin-guided therapy in respiratory tract infections. Antimicrob Agents Chemother 2011;55(12):5900-6.
Fazili T, Endy T, Javaid W, et al. Role of procalcitonin in guiding antibiotic therapy. Am J Health Syst Pharm 2012;69(23):2057-61.
Póvoa P, Salluh JI. Biomarker-guided antibiotic therapy in adult critically ill patients: a critical review. Ann Intensive Care 2012;2(1):32.
Fazili T, Endy T, Javaid W, et al. Role of procalcitonin in guiding antibiotic therapy. Am J Health Syst Pharm 2012;69(23):2057-61.
Tang J, Long W, Yan L, et al. Procalcitonin guided antibiotic therapy of acute exacerbations of asthma: a randomized controlled trial. BMC Infect Dis 2013;13:596.
Prkno A, Wacker C, Brunkhorst FM, et al. Procalcitoninguided therapy in intensive care unit patients with severe sepsis and septic shock - a systematic review and metaanalysis. Crit Care 2013;17(6):R291.
Charles PE, Kus E, Aho S, et al. Serum procalcitonin for the early recognition of nosocomial infection in the critically ill patients: a preliminary report. BMC Infect Dis 2009;9(1):49.
Nobre V, Harbarth S, Graf JD, et al. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 2008;177(5):498-505.
Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: clusterrandomised, single-blinded intervention trial. Lancet 2004;363(9409):600-7.
Harbarth S, Albrich WC, Müller B. When once is not enough--further evidence of procalcitonin-guided antibiotic stewardship. Crit Care 2009;13(4):165.
Marik PE. The clinical features of severe communityacquired pneumonia presenting as septic shock. Norasept II Study Investigators. J Crit Care 2000;15(3):85-90.
| Files | ||
| Issue | Vol 53, No 9 (2015) | |
| Section | Original Article(s) | |
| Keywords | ||
| Procalcitonin Antibiotics Intensive care unit Systemic inflammation syndrome | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
