Razazi Keyvan, Gendreau Ségolène, Cuquemelle Elise, Khellaf Mehdi, Guillaud Constance, Godeau Bertrand, Melica Giovanna, Moutereau Stéphane, Gomart Camille, Fourati Slim, De Prost Nicolas, Carteaux Guillaume, Brun-Buisson Christian, Bartolucci Pablo, Habibi Anoosha, Mekontso Dessap Armand
DHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France.
IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
J Clin Med. 2020 Nov 19;9(11):3718. doi: 10.3390/jcm9113718.
Acute chest syndrome (ACS) is a major complication of sickle-cell disease. Bacterial infection is one cause of ACS, so current guidelines recommend the routine use of antibiotics. We performed a prospective before-after study in medical wards and an intensive-care unit (ICU). During the control phase, clinicians were blinded to procalcitonin concentration results. We built an algorithm using the obtained measurements to hasten antibiotic cessation after three days of treatment if bacterial infection was not documented, and procalcitonin concentrations were all <0.5 μg/L. During the intervention period, the procalcitonin algorithm was suggested to physicians as a guide for antibiotic therapy. The primary endpoint was the number of days alive without antibiotics at Day 21. One-hundred patients were analyzed (103 ACS episodes, 60 in intervention phase). Possible or proven lung infection was diagnosed during 13% of all ACS episodes. The number of days alive without antibiotics at Day 21 was higher during the intervention phase: 15 [14-18] vs. 13 [13,14] days ( = 0.001). More patients had a short (≤3 days) antibiotic course during intervention phase: 31% vs 9% ( = 0.01). There was neither infection relapse nor pulmonary superinfection in the entire cohort. A procalcitonin-guided strategy to prescribe antibiotics in patients with ACS may reduce antibiotic exposure with no apparent adverse outcomes.
急性胸综合征（ACS）是镰状细胞病的一种主要并发症。细菌感染是ACS的一个病因，因此当前指南建议常规使用抗生素。我们在内科病房和重症监护病房（ICU）进行了一项前瞻性前后对照研究。在对照阶段，临床医生对降钙素原浓度结果不知情。我们利用获得的测量值构建了一种算法，如果未记录到细菌感染且降钙素原浓度均<0.5μg/L，则在治疗三天后加速停用抗生素。在干预期，向医生推荐降钙素原算法作为抗生素治疗的指导。主要终点是第21天时无抗生素存活的天数。对100例患者进行了分析（103次ACS发作，60次在干预期）。在所有ACS发作中，13%被诊断为可能或确诊的肺部感染。干预阶段第21天时无抗生素存活的天数更多：15[14 - 18]天对13[13,14]天（P = 0.001）。干预阶段更多患者的抗生素疗程较短（≤3天）：31%对9%（P = 0.01）。整个队列中既没有感染复发也没有肺部二重感染。在ACS患者中采用降钙素原指导的抗生素处方策略可能会减少抗生素暴露，且无明显不良后果。
