Ito Akihiro, Ishida Tadashi, Tokumasu Hironobu, Washio Yasuyoshi, Yamazaki Akio, Ito Yuhei, Tachibana Hiromasa
Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan.
Department of Respiratory Medicine, Ohara Memorial Kurashiki Healthcare Foundation, Kurashiki Central Hospital, Okayama, Japan.
J Infect Chemother. 2017 Mar;23(3):142-147. doi: 10.1016/j.jiac.2016.11.006. Epub 2016 Dec 23.
This study aimed to investigate the usefulness of procalcitonin-guided therapy in hospitalized community-acquired pneumonia patients to reduce antibiotic duration and costs without worsening prognosis.
352 hospitalized community-acquired pneumonia patients in an observational cohort study in which procalcitonin was measured three times serially, on admission (Day 1) and 2-3 days (Day 3) and 6-8 days (Day 7) after admission, between October 2010 and February 2016 were reviewed retrospectively. Antibiotics could be stopped if Day 7 procalcitonin was <0.25 ng mL or ≤10% of the higher value of procalcitonin on Day 1 or 3. Antibiotic duration and costs and recurrence and mortality rates were evaluated in mild to moderate or severe pneumonia by theoretical procalcitonin guidance for community-acquired pneumonia treatment.
Using theoretical procalcitonin guidance, antibiotic duration could be reduced from 12.6 to 8.6 days (P < 0.001), while costs could be reduced from 45,833 to 38,952 yen (P = 0.005). Among the patients in whom theoretical procalcitonin guidance could be adopted, recurrence rates (5.6% vs. 8.1%, P = 0.15) and mortality rates (0% vs. 5.1%, P = 0.07) did not worsen between the group having the same antibiotic durations as with theoretical procalcitonin guidance in actual practice (N = 71) and the group having durations more than 2 days longer in actual practice than in theoretical procalcitonin guidance (N = 198). There was no significant difference in pneumonia severity using A-DROP, CURB-65, and PSI between two groups.
Procalcitonin-guided therapy may be useful in hospitalized community-acquired pneumonia patients to reduce antibiotic duration and costs without worsening the prognosis.
本研究旨在探讨降钙素原指导治疗对住院社区获得性肺炎患者的有效性，以在不恶化预后的情况下缩短抗生素使用时间并降低费用。
回顾性分析2010年10月至2016年2月期间在一项观察性队列研究中纳入的352例住院社区获得性肺炎患者，在入院时（第1天）、入院后2 - 3天（第3天）和6 - 8天（第7天）连续3次检测降钙素原。如果第7天降钙素原<0.25 ng/mL或≤第1天或第3天降钙素原较高值的10%，则可停用抗生素。通过社区获得性肺炎治疗的理论降钙素原指导，评估轻度至中度或重度肺炎患者的抗生素使用时间、费用以及复发率和死亡率。
采用理论降钙素原指导，抗生素使用时间可从12.6天缩短至8.6天（P < 0.001），费用可从45,833日元降至38,952日元（P = 0.005）。在实际应用中抗生素使用时间与理论降钙素原指导相同的组（N = 71）和实际应用中抗生素使用时间比理论降钙素原指导长2天以上的组（N = 198）之间，在可采用理论降钙素原指导的患者中，复发率（5.6%对8.1%，P = 0.15）和死亡率（0%对5.1%，P = 0.07）并未恶化。两组间使用A - DROP、CURB - 65和PSI评估的肺炎严重程度无显著差异。
降钙素原指导治疗可能对住院社区获得性肺炎患者有用，可在不恶化预后的情况下缩短抗生素使用时间并降低费用。
