Motoa Gabriel, Pate Amy, Franco-Paredes Carlos, Chastain Daniel B, Henao-Martínez Andrés F, Hojat Leila
Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
Division of Preventive Medicine, Department of Family Medicine, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
Case Rep Infect Dis. 2020 Jan 9;2020:6342180. doi: 10.1155/2020/6342180. eCollection 2020.
Limited evidence exists for the use of procalcitonin (PCT) to guide the duration of antimicrobial therapy in patients with intra-abdominal abscesses (IAA). In this case series, we describe clinical presentations and outcomes using PCT to guide cessation of antimicrobial therapy in patients with persistent IAA who exhibited clinical improvement.
A retrospective analysis of patients with IAA who had PCT levels available to review was performed in a tertiary academic teaching institution in the United States between 2017 and 2018. Demographics, clinical characteristics, and outcomes were obtained from the medical records. Patients were followed up for a minimum of 180 days after completion of antimicrobial therapy to determine if evidence of recurrence or mortality was present.
We identified four patients with IAA. They underwent early drainage of the source of infection and received empiric antimicrobial therapy according to individual risk factors and clinical scenarios. Antimicrobials were discontinued after clinical and radiographic improvement and evidence of normal PCT levels, regardless of the persistence of fluid collections. No evidence of recurrence or mortality was observed during the follow-up period.
We found PCT to be a useful aid in the medical decision-making process to safely discontinue antimicrobial therapy in a series of patients with persistent intra-abdominal collections despite early drainage and appropriate course of antimicrobial therapy.
关于降钙素原（PCT）用于指导腹腔内脓肿（IAA）患者抗菌治疗疗程的证据有限。在本病例系列中，我们描述了使用PCT指导抗菌治疗停药的持续性IAA患者的临床表现及结局，这些患者已表现出临床改善。
2017年至2018年期间，在美国一家三级学术教学机构对有PCT水平可供审查的IAA患者进行了回顾性分析。从病历中获取人口统计学、临床特征和结局信息。抗菌治疗完成后，对患者进行至少180天的随访，以确定是否存在复发或死亡证据。
我们确定了4例IAA患者。他们接受了感染源的早期引流，并根据个体风险因素和临床情况接受了经验性抗菌治疗。在临床和影像学改善以及PCT水平正常后停用抗菌药物，无论积液是否持续存在。随访期间未观察到复发或死亡证据。
我们发现，在一系列尽管进行了早期引流和适当疗程的抗菌治疗但仍有持续性腹腔内积液的患者中，PCT有助于在医疗决策过程中安全地停用抗菌治疗。
