Subedi Bibidh, Louzon Patricia, Zappas Kristie, Onyia Wilfred, DeBoer Kevin
AdventHealth Orlando, FL, USA.
Hosp Pharm. 2020 Jun;55(3):204-210. doi: 10.1177/0018578719836643. Epub 2019 Mar 25.
Procalcitonin (PCT) is a peptide that is released in response to bacterial infections. The 2016 Infectious Diseases Society of America pneumonia guidelines recommend PCT monitoring to help guide antibiotic discontinuation. Utilization of PCT is well described in the literature; however, there is a paucity of literature regarding pharmacists' involvement for using PCT in antibiotic interventions. The objective of this study was to investigate the effect of pharmacist-led intervention with PCT-guided antibiotic therapy in critically ill patients with pneumonia. This was a pre-post study conducted at a 1368-bed community teaching hospital in the United States. A prospective cohort with pharmacist intervention utilizing PCT-algorithm guidance was compared with a retrospective historical cohort with standard therapy. Adult patients admitted to the intensive care unit (ICU) with pneumonia were included. The primary endpoint was duration of antibiotic therapy. Secondary endpoints included 28-day mortality, ICU and hospital length of stay, reinitiation of antibiotic therapy, and the incidence of infection. From August 2016 to July 2017, 113 patients were screened in the PCT group and 123 patients in the standard therapy group. Of these, 37 patients were included in the PCT group and 37 patients in the standard therapy group. Baseline characteristics were similar between the 2 groups. The antibiotic duration of therapy was 6.3 days in the PCT group versus 9.7 days in the standard therapy group ( < .001). There were no differences in secondary endpoints between the 2 groups. Clinical pharmacists' intervention with PCT-guided antibiotic therapy led to a reduction in the duration of antibiotic therapy in critically ill patients with pneumonia without increasing complications.
降钙素原（PCT）是一种在细菌感染时释放的肽。2016年美国传染病学会肺炎指南推荐监测PCT以帮助指导抗生素停用。PCT的应用在文献中有充分描述；然而，关于药师参与使用PCT进行抗生素干预的文献却很少。本研究的目的是调查药师主导的PCT指导抗生素治疗干预对重症肺炎患者的影响。这是一项在美国一家拥有1368张床位的社区教学医院进行的前后对照研究。将采用PCT算法指导的药师干预的前瞻性队列与采用标准治疗的回顾性历史队列进行比较。纳入入住重症监护病房（ICU）的成年肺炎患者。主要终点是抗生素治疗持续时间。次要终点包括28天死亡率、ICU和住院时间、抗生素治疗的重新开始以及感染发生率。2016年8月至2017年7月，PCT组筛选出113例患者，标准治疗组筛选出123例患者。其中，PCT组纳入37例患者，标准治疗组纳入37例患者。两组间基线特征相似。PCT组抗生素治疗持续时间为6.3天，标准治疗组为9.7天（P<0.001）。两组间次要终点无差异。临床药师采用PCT指导抗生素治疗的干预措施可缩短重症肺炎患者的抗生素治疗持续时间，且不增加并发症。
