Department of Pharmacy, Singapore General Hospital, Blk 8 Level 2, Singapore, 169608, Singapore.
Eur J Clin Microbiol Infect Dis. 2011 Jul;30(7):853-5. doi: 10.1007/s10096-011-1165-6. Epub 2011 Jan 29.
Clinicians have used procalcitonin (PCT) (biomarker to differentiate bacterial from non-bacterial sepsis) to guide use of antibiotics in patients. As the data for utility of PCT to discontinue antibiotics in an antimicrobial stewardship program (ASP) are lacking, we aim to describe the outcomes of patients in whom PCT was used to discontinue antibiotics under our ASP. An antimicrobial stewardship (AS) team intervened to discontinue antibiotics in patients with persistent fever or leucocytosis, source of sepsis unknown or negative bacteriological cultures, who had completed an adequate course of antibiotic therapy and had a PCT of <0.5 μg/L. Main outcomes evaluated were 14-day re-infection, 30-day mortality and readmission. Antibiotic therapy was discontinued in 42 patients in 1 year. Unknown source of sepsis was found in 38% of the patients (including possible malignant fever) and culture-negative pneumonia was found in 21%. Two patients died of advanced cancer. One patient decided for comfort care and died one week later. One patient died due to a second episode of pneumonia 37 days after first PCT test. Six patients were readmitted within 30 days due to non-infectious causes. Three patients were readmitted due to culture-negative pneumonia. None had a 14-day re-infection. PCT used to discontinue antibiotics under our ASP did not compromise patients' outcome.
临床医生一直使用降钙素原 (PCT)（一种鉴别细菌性和非细菌性败血症的生物标志物）来指导患者使用抗生素。由于缺乏 PCT 在抗菌药物管理计划 (ASP) 中用于停用抗生素的实用性数据，我们旨在描述在我们的 ASP 下使用 PCT 停用抗生素的患者的结局。抗菌药物管理 (AS) 团队会干预那些持续发热或白细胞增多、败血症的来源不明或阴性细菌培养、已完成适当疗程抗生素治疗且 PCT<0.5μg/L 的患者停用抗生素。评估的主要结局是 14 天内再感染、30 天死亡率和再入院。在 1 年内，42 名患者停用了抗生素。38%的患者败血症来源不明（包括可能的恶性发热），21%的患者为培养阴性肺炎。两名患者死于晚期癌症。一名患者因舒适护理而决定，并在一周后死亡。一名患者在首次 PCT 检测后 37 天因第二次肺炎发作而死亡。6 名患者在 30 天内因非传染性原因再次入院。3 名患者因培养阴性肺炎再次入院。均未发生 14 天内再感染。在我们的 ASP 下，使用 PCT 停用抗生素并未影响患者的结局。
