降钙素原指导抗生素治疗方案在儿科重症监护病房中的应用。

Use of a Procalcitonin-guided Antibiotic Treatment Algorithm in the Pediatric Intensive Care Unit.

机构信息

From the Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN.

College of Medicine, The University of Tennessee Health Science Center, Memphis, TN.

出版信息

Pediatr Infect Dis J. 2021 Apr 1;40(4):333-337. doi: 10.1097/INF.0000000000002986.

DOI:10.1097/INF.0000000000002986

PMID:33181782

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7954892/

Abstract

BACKGROUND

The utility of procalcitonin testing in the pediatric intensive care unit (PICU) is not known. We sought to determine the impact of a procalcitonin-guided antibiotic treatment algorithm implemented with antibiotic stewardship (AS) guidance vs. usual care on antibiotic use in critically ill children.

METHODS

Single center, pragmatic, randomized prospective clinical trial of critically ill children admitted to an ICU setting and started on intravenous antibiotics from February 15, 2018, to April 11, 2019. Patients were assigned on a monthly basis to either the procalcitonin or usual care arm. The procalcitonin arm had procalcitonin testing on hospital days 0, 1, 2, and 4 and stewardship assistance with algorithm result interpretation. Both arms had routine AS audit and feedback. The primary outcome was median antibiotic days of therapy per patient in the first 14-days after enrollment.

RESULTS

Among 270 patients, 137 were in the procalcitonin arm and 133 in the usual care arm. Antibiotic days of therapy (DOT) were not significantly different between the procalcitonin arm (6.6, IQR: 3.1-10.9) and the usual care arm (7.6, IQR: 3-11.8; P = 0.37). More AS recommendations were made in the procalcitonin vs. control arm (54 vs. 37; P = 0.03). Adherence with algorithm-based antibiotic recommendations was high in the procalcitonin arm (70%).

CONCLUSIONS

We found no difference in antibiotic DOT between study arms. This trial was underpowered but demonstrates feasibility of using a procalcitonin-guided antibiotic treatment algorithm with AS audit and feedback in the PICU.

摘要

背景

降钙素原检测在儿科重症监护病房（PICU）中的应用尚不清楚。我们旨在确定与常规护理相比，在重症监护病房中实施降钙素原指导抗生素治疗算法与抗生素管理（AS）指导相结合，对危重症儿童抗生素使用的影响。

方法

这是一项单中心、实用、随机前瞻性临床试验，纳入 2018 年 2 月 15 日至 2019 年 4 月 11 日期间入住 ICU 并开始静脉使用抗生素的危重症儿童。患者每月按降钙素原或常规护理组进行分组。降钙素原组在住院第 0、1、2 和 4 天进行降钙素原检测，并在算法结果解读方面获得管理协助。两组均进行常规 AS 审核和反馈。主要结局是入组后 14 天内每位患者的抗生素治疗天数中位数。

结果

在 270 名患者中，137 名患者在降钙素原组，133 名患者在常规护理组。降钙素原组的抗生素治疗天数（DOT）（6.6，IQR：3.1-10.9）与常规护理组（7.6，IQR：3-11.8；P=0.37）无显著差异。降钙素原组比对照组提出了更多的 AS 建议（54 对 37；P=0.03）。降钙素原组的抗生素推荐方案的遵循率较高（70%）。