Maseda Emilio, Suarez-de-la-Rica Alejandro, Anillo Víctor, Tamayo Eduardo, García-Bernedo Carlos A, Ramasco Fernando, Villagran Maria-Jose, Maggi Genaro, Gimenez Maria-Jose, Aguilar Lorenzo, Granizo Juan-José, Buño Antonio, Gilsanz Fernando
Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
J Crit Care. 2015 Jun;30(3):537-42. doi: 10.1016/j.jcrc.2014.12.014. Epub 2014 Dec 31.
Because procalcitonin (PCT) might be surrogate for antimicrobial discontinuation in general intensive care units (ICUs), this study explored its use for secondary peritonitis in 4 surgical ICUs (SICUs).
A retrospective study including all consecutive patients with secondary peritonitis, controlled infection source, requiring surgery, and at least 48-hour SICU admission was performed (June 2012-June 2013). Patients were divided following notations in medical records into PCT-guided (notation of PCT-based antibiotic discontinuation) and non-PCT-guided (no notation) groups.
A total of 121 patients (52 PCT-guided, 69 non-PCT-guided) were included. No differences in clinical scores, biomarkers, or septic shock (30 [57.7%] PCT-guided vs 40 [58.0%] non-PCT-guided) were found. Length of intra-SICU (median, 5.0 days; both groups) or in-hospital (median, 20.0 vs 17.5 days) stay, and mortality intra-SICU (9.6% vs 13.0%), 28-day (15.4% vs 20.3%), or in-hospital (19.2% vs 29.0%) were not significantly different (PCT-guided vs non-PCT-guided). In septic shock patients, no mortality differences were found (PCT-guided vs non-PCT-guided): 16.7% vs 22.5% (intra-SICU), 26.7% vs 32.5% (28-day), and 33.3% vs 42.5% (in-hospital). Treatment was shorter in the PCT-guided group (5.1 ±2.1 vs 10.2 ± 3.7 days, P < .001), without differences between patients with and without septic shock.
Procalcitonin guidance produced 50% reduction in antibiotic duration (P < .001, log-rank test).
鉴于降钙素原（PCT）可能是普通重症监护病房（ICU）停用抗菌药物的替代指标，本研究探讨了其在4个外科ICU（SICU）中用于继发性腹膜炎的情况。
进行一项回顾性研究，纳入所有连续性继发性腹膜炎患者，控制感染源，需要手术治疗，且至少入住SICU 48小时（2012年6月至2013年6月）。根据病历记录将患者分为PCT引导组（基于PCT停用抗生素的记录）和非PCT引导组（无记录）。
共纳入121例患者（52例PCT引导组，69例非PCT引导组）。在临床评分、生物标志物或感染性休克方面未发现差异（PCT引导组30例[57.7%] vs非PCT引导组40例[58.0%]）。SICU住院时间（中位数，5.0天；两组）或住院时间（中位数，20.0天vs 17.5天），以及SICU内死亡率（9.6% vs 13.0%）、28天死亡率（15.4% vs 20.3%）或住院死亡率（19.2% vs 29.0%）均无显著差异（PCT引导组vs非PCT引导组）。在感染性休克患者中，未发现死亡率差异（PCT引导组vs非PCT引导组）：SICU内为16.7% vs 22.5%，28天为26.7% vs 32.5%，住院期间为33.3% vs 42.5%。PCT引导组的治疗时间较短（5.1±2.1天vs 10.2±3.7天，P <.001），有感染性休克和无感染性休克的患者之间无差异。
降钙素原引导使抗生素使用时间缩短了50%（P <.001，对数秩检验）。
