基于降钙素原的治疗策略以减少心脏手术后患者的抗生素使用：一项随机对照试验。
Procalcitonin-based therapeutic strategy to reduce antibiotic use in patients after cardiac surgery: a randomized controlled trial.
作者信息
Maravić-Stojković Vera, Lausević-Vuk Ljiljana, Jović Miomir, Ranković Aleksandra, Borzanović Milorad, Marinković Jelena
机构信息
Immunology Lab, Dedinje Cardiovascular Institute, Belgrade, Serbia.
出版信息
Srp Arh Celok Lek. 2011 Nov-Dec;139(11-12):736-42.
INTRODUCTION
Procalcitonin (PCT) is a thyroid gland prohormone, and its serum concentration is elevated in systemic bacterial infections. The diagnostic cut-off value of PCT in patients early after cardiac surgery remains unclear.
OBJECTIVE
We investigated whether procalcitonin-guidance could reduce antibiotic usage safely.
METHODS
The prospective study included 205 patients who underwent open heart surgery. The patients were randomly assigned for procalcitonin-guided antibiotic treatment (PCT-group; n = 102) or standard care (standard group; n = 103). On the basis of serum procalcitonin concentrations, usage of antibiotics was encouraged (PCT > or = 0.5 ng/mL) or discouraged.
RESULTS
A relative risk of antibiotic exposure in the standard group compared with the PCT-group was 3.81 (95% CI = 2.03-7.17; p < 0.0001). The mean cost of antibiotics per patient in procalcitonin group was Euro 193.3 +/- 636.6 vs. Euro 372.1 +/- 841.1 (p = 0.206) in the standard group, while the mean cost per hospital day was Euro 8.0 +/- 18.4 vs. Euro 17.8 +/- 36.3 (p = 0.028). We found that non-infectious complications occurred in 40/102 vs. 41/103 (p = 0.592) while infections appeared in 5/102 vs. 22/103 (p = 0.001) cases. A statistically significant difference was observed in the treatment of urinary infections between PCT-group and standard group; 1/102 vs. 9/103 (p = 0.016). In the PCT-group, the ICU stay was 5.74 +/- 11.49 days and in the standard group 6.97 +/- 11.61 (p = 0.812). The hospital stay was 12.08 +/- 11.28 vs. 12.93 +/- 10.73 (p > 0.05) days, respectively. Mortality rates were equal in both groups of patients (p = 0.537).
CONCLUSION
Procalcitonin-guided antibiotic treatment is safe and can significantly reduce the cost of postoperative care. Additionally, the antibiotic use during immediate postoperative course should be timely controlled and limited to documented bacterial infections.
引言
降钙素原（PCT）是一种甲状腺前激素，其血清浓度在全身性细菌感染时会升高。心脏手术后早期患者中PCT的诊断临界值仍不明确。
目的
我们研究了降钙素原指导是否能安全地减少抗生素使用。
方法
这项前瞻性研究纳入了205例行心脏直视手术的患者。患者被随机分配接受降钙素原指导的抗生素治疗（PCT组；n = 102）或标准治疗（标准组；n = 103）。根据血清降钙素原浓度，鼓励（PCT≥0.5 ng/mL）或不鼓励使用抗生素。
结果
与PCT组相比，标准组抗生素暴露的相对风险为3.81（95%CI = 2.03 - 7.17；p < 0.0001）。降钙素原组每位患者的抗生素平均费用为193.3±636.6欧元，而标准组为372.1±841.1欧元（p = 0.206），而每日住院平均费用分别为8.0±18.4欧元和17.8±36.3欧元（p = 0.028）。我们发现，非感染性并发症在40/102例患者中发生，而在41/103例患者中发生（p = 0.592），感染则在5/102例患者中出现，而在22/103例患者中出现（p = 0.001）。PCT组和标准组在尿路感染治疗方面存在统计学显著差异；1/102例与9/103例（p = 0.016）。在PCT组，ICU住院时间为5.74±11.49天，在标准组为6.97±11.61天（p = 0.812）。住院时间分别为12.08±11.28天和12.93±10.73天（p > 0.05）。两组患者的死亡率相等（p = 0.537）。
结论
降钙素原指导的抗生素治疗是安全的，并且可以显著降低术后护理成本。此外，术后即刻的抗生素使用应及时控制，并仅限于有记录的细菌感染。
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