Pharmacie Hospitalière, CHU Dijon Bourgogne, 14 rue Paul Gaffarel, B.P. 77908-21079, Dijon, Cedex, France.
Service de Médecine Intensive-Réanimation, CHU Dijon Bourgogne, 14 rue Paul Gaffarel, B.P. 77908-21079, Dijon, Cedex, France.
J Crit Care. 2019 Oct;53:125-131. doi: 10.1016/j.jcrc.2019.05.022. Epub 2019 May 31.
Ventilator-associated pneumonia (VAP) increases exposure to antibiotics. Physicians are however reluctant to shorten treatment, arguing this could lead to failures and worse outcome. Monitoring procalcitonin (PCT) has proven effective for decreasing exposure to antibiotics in randomized controlled trials, but additional "real-life" studies are needed.
All patients with VAP in whom ABT was stopped before death or discharge were included in this 5-year prospective cohort study. Patients in whom ABT was stopped in accordance with the algorithm ("PCT-guided" group: ABT withdrawal strongly encouraged if PCT < 0.5 ng/mL or < 80% peak value) were compared to those with ABT continuation despite PCT decrease ("not PCT-guided" group). The primary endpoint was ABT duration. The secondary endpoint was unfavorable VAP outcome (i.e. death or relapse).
We included 157 of the 316 patients with microbiologically-proven VAP. The algorithm was overruled in 81 patients (51.6%). ABT duration was significantly longer in these patients than in the PCT-guided group (9.5 vs. 8.0 days; p = .02), although baseline and VAP characteristics did not differ. The rate of unfavorable outcomes was comparable (46.9% vs. 51.3%; p = .69).
PCT-guided ABT adherence appears safe for patients with VAP and is likely to reduce exposure to antibiotics.
呼吸机相关性肺炎（VAP）会增加抗生素的暴露量。然而，医生不愿意缩短治疗时间，他们认为这可能导致治疗失败和更糟糕的结果。降钙素原（PCT）监测已被证明在随机对照试验中可有效减少抗生素的暴露，但仍需要更多的“真实世界”研究。
本 5 年前瞻性队列研究纳入了所有在死亡或出院前停用 ABT 的 VAP 患者。将根据算法停用 ABT 的患者（如果 PCT<0.5ng/mL 或<80%峰值，则强烈鼓励停止 ABT）与尽管 PCT 下降仍继续使用 ABT 的患者（未进行 PCT 指导组）进行比较。主要终点是 ABT 持续时间。次要终点是 VAP 结局不良（即死亡或复发）。
我们纳入了 316 例微生物确诊的 VAP 患者中的 157 例。该算法在 81 例患者（51.6%）中被推翻。与 PCT 指导组相比，这些患者的 ABT 持续时间明显更长（9.5 天 vs. 8.0 天；p=0.02），尽管基线和 VAP 特征没有差异。不良结局的发生率相似（46.9% vs. 51.3%；p=0.69）。
PCT 指导的 ABT 依从性似乎对 VAP 患者是安全的，并且可能减少抗生素的暴露。
