Venkatesh B, Kennedy P, Kruger P S, Looke D, Jones M, Hall J, Barruel G Ray
Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Anaesth Intensive Care. 2009 Jan;37(1):20-6. doi: 10.1177/0310057X0903700102.
Serial procalcitonin is reported to be useful to titrate duration of antibiotic therapy in the non critically ill patient with pneumonia. The aim of this study was to examine the relationship between antibiotic therapy and serial serum procalcitonin concentrations in a cohort of critically ill septic patients and examine for any differences between culture positive (CP) and culture negative (CN) sepsis. Seventy-five critically ill patients with suspected sepsis were enrolled in this prospective observational study. Serial procalcitonin and C-reactive protein assays were measured on days one, three, five, seven, 10 and 14. The mean duration of antibiotic therapy was similar in the two groups (10.4 +/- 5.1 (CP) vs. 8.4 +/- 5.1 (CN) days, P = 0.09). Serum procalcitonin concentrations were significantly higher at baseline in the CP than the CN group (14.9 +/- 22.9 vs. 6.8 +/- 21.5 ng/ml, P = 0.04). During the study period, serum concentrations of procalcitonin and C-reactive protein declined in both groups. Serum procalcitonin consistently remained higher in the CP group (P < 0.05) and did not return to normal values. In the CN group, procalcitonin concentrations fell below 0.5 only on day 10. There was no significant difference in C-reactive protein profile between the two groups. Four patients in the CP group (11%) had relapse of sepsis. The mean procalcitonins in the relapsed subgroup were lower than those in the remission subgroup (P = 0.02). Therapy for proven or presumed infections was associated with declining serum procalcitonin and C-reactive protein in critically ill septic patients. The marked variability and overlap in plasma profile of these markers between CP and CN sepsis makes it difficult to define a nadir plasma concentration at which one can recommend discontinuation of antibiotic therapy.
据报道，对于非重症肺炎患者，连续监测降钙素原有助于确定抗生素治疗的疗程。本研究的目的是探讨重症脓毒症患者队列中抗生素治疗与连续血清降钙素原浓度之间的关系，并检查培养阳性（CP）和培养阴性（CN）脓毒症之间的差异。75例疑似脓毒症的重症患者纳入了这项前瞻性观察研究。在第1、3、5、7、10和14天测量连续降钙素原和C反应蛋白检测值。两组的抗生素治疗平均疗程相似（10.4±5.1（CP）天 vs. 8.4±5.1（CN）天，P = 0.09）。CP组基线时血清降钙素原浓度显著高于CN组（14.9±22.9 vs. 6.8±21.5 ng/ml，P = 0.04）。在研究期间，两组的血清降钙素原和C反应蛋白浓度均下降。CP组的血清降钙素原持续保持较高水平（P < 0.05）且未恢复至正常水平。在CN组，降钙素原浓度仅在第10天降至0.5以下。两组之间的C反应蛋白情况无显著差异。CP组有4例患者（11%）脓毒症复发。复发亚组的平均降钙素原低于缓解亚组（P = 0.02）。对于重症脓毒症患者，针对已证实或疑似感染的治疗与血清降钙素原和C反应蛋白下降有关。这些标志物在CP和CN脓毒症之间的血浆水平存在显著变异性和重叠，使得难以确定一个能推荐停用抗生素治疗的最低血浆浓度。
