еКорпус – библиографски запис
Procalcitonin-Based Therapeutic Strategy to Reduce Antibiotic Use in Patients after Cardiac Surgery: A Randomized Controlled Trial
ТЕРАПИЈСКА СТРАТЕГИЈА ЗАСНОВАНА НА МЕРЕЊУ КОНЦЕНТРАЦИЈЕ ПРОКАЛЦИТОНИНА РАДИ СМАЊЕЊА ПРИМЕНЕ АНТИБИОТИКА КОД БОЛЕСНИКА ПОДВРГНУТИХ КАРДИОХИРУРШКОМ ЛЕЧЕЊУ: РАНДОМИЗИРАНО КОНТРОЛИСАНО ИСТРАЖИВАЊЕ
- Часопис
- Serbian Archives of Medicine
- Објављено
- Srp Arh Celok Lek. 2011;139(11–12):736–742.
- Врста рада
- ORIGINAL ARTICLES
Abstract
Introduction Procalcitonin (PCT) is a thyroid gland prohormone, and its serum concentration is elevated in systemic bacterial infections. The diagnostic cut-off value of PCT in patients early after cardiac surgery remains unclear.
Objective We investigated whether procalcitonin-guidance could reduce antibiotic usage safely.
Methods The prospective study included 205 patients who underwent open heart surgery. The patients were randomly assigned for procalcitonin-guided antibiotic treatment (PCT-group; n=102) or standard care (standard group; n=103). On the basis of serum procalcitonin concentrations, usage of antibiotics was encouraged (PCT≥0.5 ng/mL) or discouraged.
Results A relative risk of antibiotic exposure in the standard group compared with the PCT-group was 3.81 (95% CI=2.03-7.17; p<0.0001). The mean cost of antibiotics per patient in procalcitonin group was €193.3±636.6 vs. €372.1±841.1 (p=0.206) in the standard group, while the mean cost per hospital day was €8.0±18.4 vs. €17.8±36.3 (p=0.028). We found that non-infectious complications occurred in 40/102 vs. 41/103 (p=0.592) while infections appeared in 5/102 vs. 22/103 (p=0.001) cases. A statistically significant difference was observed in the treatment of urinary infections between PCT-group and standard group; 1/102 vs. 9/103 (p=0.016). In the PCT-group, the ICU stay was 5.74±11.49 days and in the standard group 6.97±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 of patients (p=0.537).
Conclusion Procalcitonin-guided antibiotic treatment is safe and can significantly reduce the cost of postoperative care. Additionally, the antibiotic use during immediate postoperative course should be timely controlled and limited to documented bacterial infections.
Keywords: procalcitonin; antibiotics; inflammatory mediators; cardiac surgery