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Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: The antibiotic overuse in critically ill patients with sepsis increases risk of bacterial resistance and prolonged use can lead to adverse effects. Objective: Our objective was to assess whether the decrease in procalcitonin (PCT) levels could be used to reduce the time of antibiotic without worsening the prognosis in intensive care patients.
Methods: From March 2008 to October 2009 we randomized 70 septic patients with bacterial infection proven by cultures. This study was conducted in a 38-bed medical-surgical ICU in a tertiary care hospital. In the intervention group, the PCT was measured in the first and fifth day of treatment (but in the seventh day only for bloodstream infection) and antibiotic was stopped when PCT decreased 90% or more from the initial level. In the control group the time of treatment was based on clinical evaluation.
Results: In the intention to treat analysis, the median antibiotic duration was 10 days treatment in PCT group (N=34) vs. 12 days treatment in non-PCT group (N=36), p=0.53. In the analysis per protocol (N=40), the median antibiotic duration was 9 days treatment in PCT group (N=14) vs. 15 days treatment in non-PCT group (N=26), p=0.012. More than a half of the patient had bloodstream infections (52.5%). Mortality did not differ significantly between PCT and control group (5.6% vs. 11.8%, respectively; p=0.3) and no difference in recurrence of infection was found (7.1% vs. 3.8%; p=0.58).
Conclusions: This study demonstrates that PCT can be an useful tool for limiting antimicrobial therapy in the ICU patients with bacterial infection proven by cultures. It is not harmful to the clinical outcome of critically ill patients.
Methods: From March 2008 to October 2009 we randomized 70 septic patients with bacterial infection proven by cultures. This study was conducted in a 38-bed medical-surgical ICU in a tertiary care hospital. In the intervention group, the PCT was measured in the first and fifth day of treatment (but in the seventh day only for bloodstream infection) and antibiotic was stopped when PCT decreased 90% or more from the initial level. In the control group the time of treatment was based on clinical evaluation.
Results: In the intention to treat analysis, the median antibiotic duration was 10 days treatment in PCT group (N=34) vs. 12 days treatment in non-PCT group (N=36), p=0.53. In the analysis per protocol (N=40), the median antibiotic duration was 9 days treatment in PCT group (N=14) vs. 15 days treatment in non-PCT group (N=26), p=0.012. More than a half of the patient had bloodstream infections (52.5%). Mortality did not differ significantly between PCT and control group (5.6% vs. 11.8%, respectively; p=0.3) and no difference in recurrence of infection was found (7.1% vs. 3.8%; p=0.58).
Conclusions: This study demonstrates that PCT can be an useful tool for limiting antimicrobial therapy in the ICU patients with bacterial infection proven by cultures. It is not harmful to the clinical outcome of critically ill patients.