Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland.
Virulence. 2010 Mar-Apr;1(2):88-92. doi: 10.4161/viru.1.2.10488.
In the recently published ProHOSP trial, we investigated the safety and external validity of procalcitonin (PCT) guidance for antibiotic therapy in patients with different severities of lower respiratory tract infections, mainly pneumonia. In this addendum, we aim to extend the initial report by reinforcing the rational of the PCT algorithm and by presenting more detailed data on antibiotic therapy in different severities of infection. In milder, mostly viral respiratory infections (i.e. acute or chronic bronchitis) initial prescription of antibiotics was markedly reduced by PCT guidance because PCT remained low in most patients. In pneumonia, PCT showed a severity-dependent increase and highest levels in patients with positive blood cultures. Thus, the main effect in pneumonia was a severity- and bacteremia-adapted reduction of the duration of antibiotic courses. In lower respiratory tract infections, PCT guidance had a differential effect on antibiotic exposure depending on the underlying type and severity of respiratory tract infection.
在最近发表的 ProHOSP 试验中，我们研究了降钙素原 (PCT) 指导下抗生素治疗下呼吸道感染（主要是肺炎）不同严重程度患者的安全性和外部有效性。在本增刊中，我们旨在通过强化 PCT 算法的合理性并提供感染严重程度不同时更详细的抗生素治疗数据来扩展初始报告。在较轻的、主要是病毒性呼吸道感染（即急性或慢性支气管炎）中，PCT 指导明显减少了抗生素的初始处方，因为大多数患者的 PCT 仍然较低。在肺炎中，PCT 显示出与严重程度相关的增加，在血培养阳性的患者中达到最高水平。因此，肺炎的主要作用是根据严重程度和菌血症调整抗生素疗程的持续时间。在下呼吸道感染中，PCT 指导根据潜在的呼吸道感染类型和严重程度对抗生素暴露产生了不同的影响。
