Use of Procalcitonin to Shorten Antibiotic Treatment Duration in Septic Patients: A Randomized Trial

The duration of antibiotic therapy in critically ill patients with sepsis can result in antibiotic overuse, increasing the risk of developing bacterial resistance. To test the hypothesis that an algorithm based on serial measurements of procalcitonin (PCT) allows reduction in the duration of antibio...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine Vol. 177; no. 5; pp. 498 - 505
Main Authors: Nobre, Vandack, Harbarth, Stephan, Graf, Jean-Daniel, Rohner, Peter, Pugin, Jerome
Format: Journal Article
Language:English
Published: New York, NY Am Thoracic Soc 01.03.2008
American Lung Association
American Thoracic Society
Subjects:
Aged
Aged, 80 and over
Algorithms
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anti-Bacterial Agents - administration & dosage
Antibacterial agents
Antibiotics
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antimicrobial agents
Bacterial infections
Biological and medical sciences
Biomarkers
Calcitonin - blood
Calcitonin Gene-Related Peptide
Clinical Protocols
Critical Illness
Female
Glycoproteins - blood
Humans
Infections
Intensive care
Intensive care medicine
Kaplan-Meier Estimate
Length of Stay
Male
Medical sciences
Middle Aged
Patients
Pharmacology. Drug treatments
Pneumonia
Protein Precursors - blood
Recurrence
Sepsis
Sepsis - blood
Sepsis - drug therapy
Sepsis - mortality
Shock, Septic - blood
Shock, Septic - drug therapy
Shock, Septic - mortality
Human
Infection
Sepsis syndrome
Antibiotic
Intensive care
Treatment
controlled trial
Procalcitonin
antibiotics
Resuscitation
sepsis
ISSN:1073-449X, 1535-4970, 1535-4970
Online Access:Get full text
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Summary:The duration of antibiotic therapy in critically ill patients with sepsis can result in antibiotic overuse, increasing the risk of developing bacterial resistance. To test the hypothesis that an algorithm based on serial measurements of procalcitonin (PCT) allows reduction in the duration of antibiotic therapy compared with empirical rules, and does not result in more adverse outcomes in patients with severe sepsis and septic shock. In patients randomly assigned to the intervention group, antibiotics were stopped when PCT levels had decreased 90% or more from the initial value (if clinicians agreed) but not before Day 3 (if baseline PCT levels were <1 microg/L) or Day 5 (if baseline PCT levels were >/=1 microg/L). In control patients, clinicians decided on the duration of antibiotic therapy based on empirical rules. Patients assigned to the PCT group had 3.5-day shorter median duration of antibiotic therapy for the first episode of infection than control subjects (intention-to-treat, n = 79, P = 0.15). In patients in whom a decision could be taken based on serial PCT measurements, PCT guidance resulted in a 4-day reduction in the duration of antibiotic therapy (per protocol, n = 68, P = 0.003) and a smaller overall antibiotic exposure (P = 0.0002). A similar mortality and recurrence of the primary infection were observed in PCT and control groups. A 2-day shorter intensive care unit stay was also observed in patients assigned to the PCT group (P = 0.03). Our results suggest that a protocol based on serial PCT measurement allows reducing antibiotic treatment duration and exposure in patients with severe sepsis and septic shock without apparent harm.
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ISSN:1073-449X
1535-4970
1535-4970
DOI:10.1164/rccm.200708-1238OC