Clinical and economic impact of procalcitonin to shorten antimicrobial therapy in septic patients with proven bacterial infection in an intensive care setting |
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| Authors: | Rodrigo Octavio Deliberato,Alexandre R. Marra,Paula Rodrigues Sanches,Marines Dalla Valle Martino,Carlos Eduardo dos Santos Ferreira,Jacyr Pasternak,Angela Tavares Paes,Lilian Moreira Pinto,Oscar Fernando Pavã o dos Santos,Michael B. Edmond |
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| Affiliation: | 1. Critical Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil;2. Microbiology Laboratory Department, Hospital Israelita Albert Einstein, São Paulo, Brazil;3. Statistics Department, Instituto Israelita de Ensino e Pesquisa (IIEP), São Paulo, Brazil;4. Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA |
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| Abstract: | Biomarkers such as procalcitonin (PCT) have been studied to guide duration of antibiotic therapy. We aimed to assess whether a decrease in PCT levels could be used to reduce the duration of antibiotic therapy in intensive care unit (ICU) patients with a proven infection without risking a worse outcome. We assessed 265 patients with suspected sepsis, severe sepsis, or septic shock in our ICU. Of those, we randomized 81 patients with a proven bacterial infection into 2 groups: an intervention group in which the duration of the antibiotic therapy was guided by a PCT protocol and a control group in which there was no PCT guidance. In the per-protocol analysis, the median antibiotic duration was 9 days in the PCT group (n = 20) versus 13 days in the non-PCT group (n = 31), P = 0.008. This study demonstrates that PCT can be a useful tool for limiting antimicrobial therapy in ICU patients with documented bacterial infection. |
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| Keywords: | Procalcitonin Sepsis Severe sepsis Septic shock Antimicrobial therapy Antibiotic therapy Cost |
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