Procalcitonin-based therapeutic strategy to reduce antibiotic use in patients after cardiac surgery: A randomized controlled trial

Srpski Arhiv za Celokupno Lekarstvo

关键词: procalcitonin;    antibiotics;    inflammatory mediators;    cardiac surgery;   

DOI  :  10.2298/SARH1112736M

来源: DOAJ

【 摘 要 】

Introduction. Procalcitonin (PCT) is a thyroid gland prohormone, and itsserum concentration is elevated in systemic bacterial infections. Thediagnostic cut-off value of PCT in patients early after cardiac surgeryremains unclear. Objective. We investigated whether procalcitonin-guidancecould reduce antibiotic usage safely. Methods. The prospective study included205 patients who underwent open heart surgery. The patients were randomlyassigned for procalcitonin-guided antibiotic treatment (PCT-group; n=102) orstandard care (standard group; n=103). On the basis of serum procalcitoninconcentrations, usage of antibiotics was encouraged (PCT≥0.5 ng/mL) ordiscouraged. Results. A relative risk of antibiotic exposure in the standardgroup compared with the PCT-group was 3.81 (95% CI=2.03-7.17; p<0.0001). Themean cost of antibiotics per patient in procalcitonin group was €193.3±636.6vs. €372.1±841.1 (p=0.206) in the standard group, while the mean cost perhospital day was €8.0±18.4 vs. €17.8±36.3 (p=0.028). We found thatnon-infectious complications occurred in 40/102 vs. 41/103 (p=0.592) whileinfections appeared in 5/102 vs. 22/103 (p=0.001) cases. A statisticallysignificant difference was observed in the treatment of urinary infectionsbetween PCT-group and standard group; 1/102 vs. 9/103 (p=0.016). In thePCT-group, the ICU stay was 5.74±11.49 days and in the standard group6.97±11.61 (p=0.812). The hospital stay was 12.08±11.28 vs. 12.93±10.73(p>0.05) days, respectively. Mortality rates were equal in both groups ofpatients (p=0.537). Conclusion. Procalcitonin-guided antibiotic treatment issafe and can significantly reduce the cost of postoperative care.Additionally, the antibiotic use during immediate postoperative course shouldbe timely controlled and limited to documented bacterial infections.

【 授权许可】

Unknown