학술논문
Procalcitonin-guided therapy may reduce length of antibiotic treatment in intensive care unit patients with secondary peritonitis: A multicenter retrospective study.
Document Type
Academic Journal
Author
Maseda E; Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. Electronic address: emilio.maseda@gmail.com.; Suarez-de-la-Rica A; Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.; Anillo V; Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.; Tamayo E; Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario, Avenida Ramón y Cajal 3, 47005 Valladolid, Spain.; García-Bernedo CA; Anesthesiology and Surgical Critical Care Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003 Barcelona, Spain.; Ramasco F; Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Princesa, Diego de Leon 62, 28006 Madrid, Spain.; Villagran MJ; Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.; Maggi G; Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.; Gimenez MJ; PRISM-AG, Don Ramon de la Cruz 72, 28006 Madrid, Spain.; Aguilar L; PRISM-AG, Don Ramon de la Cruz 72, 28006 Madrid, Spain.; Granizo JJ; Preventive Medicine Department, Hospital Infanta Cristina, Avenida 9 de junio 2, 28981 Parla, Madrid, Spain.; Buño A; Clinical Analysis Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.; Gilsanz F; Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
Source
Publisher: W.B. Saunders Country of Publication: United States NLM ID: 8610642 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-8615 (Electronic) Linking ISSN: 08839441 NLM ISO Abbreviation: J Crit Care Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: Because procalcitonin (PCT) might be surrogate for antimicrobial discontinuation in general intensive care units (ICUs), this study explored its use for secondary peritonitis in 4 surgical ICUs (SICUs).
Methods: A retrospective study including all consecutive patients with secondary peritonitis, controlled infection source, requiring surgery, and at least 48-hour SICU admission was performed (June 2012-June 2013). Patients were divided following notations in medical records into PCT-guided (notation of PCT-based antibiotic discontinuation) and non-PCT-guided (no notation) groups.
Results: A total of 121 patients (52 PCT-guided, 69 non-PCT-guided) were included. No differences in clinical scores, biomarkers, or septic shock (30 [57.7%] PCT-guided vs 40 [58.0%] non-PCT-guided) were found. Length of intra-SICU (median, 5.0 days; both groups) or in-hospital (median, 20.0 vs 17.5 days) stay, and mortality intra-SICU (9.6% vs 13.0%), 28-day (15.4% vs 20.3%), or in-hospital (19.2% vs 29.0%) were not significantly different (PCT-guided vs non-PCT-guided). In septic shock patients, no mortality differences were found (PCT-guided vs non-PCT-guided): 16.7% vs 22.5% (intra-SICU), 26.7% vs 32.5% (28-day), and 33.3% vs 42.5% (in-hospital). Treatment was shorter in the PCT-guided group (5.1 ±2.1 vs 10.2 ± 3.7 days, P < .001), without differences between patients with and without septic shock.
Conclusion: Procalcitonin guidance produced 50% reduction in antibiotic duration (P < .001, log-rank test).
(Copyright © 2014 Elsevier Inc. All rights reserved.)
Methods: A retrospective study including all consecutive patients with secondary peritonitis, controlled infection source, requiring surgery, and at least 48-hour SICU admission was performed (June 2012-June 2013). Patients were divided following notations in medical records into PCT-guided (notation of PCT-based antibiotic discontinuation) and non-PCT-guided (no notation) groups.
Results: A total of 121 patients (52 PCT-guided, 69 non-PCT-guided) were included. No differences in clinical scores, biomarkers, or septic shock (30 [57.7%] PCT-guided vs 40 [58.0%] non-PCT-guided) were found. Length of intra-SICU (median, 5.0 days; both groups) or in-hospital (median, 20.0 vs 17.5 days) stay, and mortality intra-SICU (9.6% vs 13.0%), 28-day (15.4% vs 20.3%), or in-hospital (19.2% vs 29.0%) were not significantly different (PCT-guided vs non-PCT-guided). In septic shock patients, no mortality differences were found (PCT-guided vs non-PCT-guided): 16.7% vs 22.5% (intra-SICU), 26.7% vs 32.5% (28-day), and 33.3% vs 42.5% (in-hospital). Treatment was shorter in the PCT-guided group (5.1 ±2.1 vs 10.2 ± 3.7 days, P < .001), without differences between patients with and without septic shock.
Conclusion: Procalcitonin guidance produced 50% reduction in antibiotic duration (P < .001, log-rank test).
(Copyright © 2014 Elsevier Inc. All rights reserved.)