National Health Laboratory Services, South Africa and Faculty of Health Sciences, Helen Joseph Academic Hospital, University of the Witwatersrand, South Africa.
Department of Surgery, Faculty of Health Sciences, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, South Africa.
S Afr J Surg. 2020 Sep;5(3):143-149.
Biomarkers like procalcitonin (PCT) are an important antimicrobial stewardship tool for critically ill patients. There is little evidence regarding the use of PCT-guided antibiotic algorithms in developing countries. Evidence is also lacking for PCT-based antibiotic algorithms in surgical trauma patients admitted to the intensive care unit (ICU).
A prospective, two period cross-over study was conducted in a surgical trauma intensive care unit in South Africa. In the first period, 40 patients were recruited into the control group and antibiotics were discontinued as per standard of care. In the second period, 40 patients were recruited into the procalcitonin group and antibiotics were discontinued if the PCT decreased by ≥ 80% from the peak PCT level, or to an absolute value of less than 0.5 μg/L. Antibiotic duration of treatment was the primary outcome. Patients were followed up for 28 days from the first sepsis event.
For the first sepsis event the PCT group had a mean antibiotic duration of 9.3 days while the control group had a mean duration of 10.9 days ( = 0.10). Patients in the intervention group had higher mean (SD) antibiotic free days alive of 7.7 (6.57) days compared to the control group mean (SD) of 3.8 (5.22) days, ( = 0.004). In-hospital mortality rate was lower in the intervention group (15%) compared to the control group (30%) and was statistically significant ( = 0.045).
There was no significant difference in duration of antibiotic treatment between the two groups. However, the PCT group had more antibiotic free days alive and lower in-hospital mortality compared to the control group.
降钙素原 (PCT) 等生物标志物是危重症患者抗菌药物管理的重要工具。关于在发展中国家使用 PCT 指导抗生素算法的证据很少。在入住重症监护病房 (ICU) 的外科创伤患者中，也缺乏基于 PCT 的抗生素算法的证据。
在南非的一个外科创伤重症监护病房进行了一项前瞻性、两期交叉研究。在第一期，40 名患者被纳入对照组，按照标准治疗方案停用抗生素。在第二期，40 名患者被纳入 PCT 组，如果 PCT 从峰值 PCT 水平下降≥80%，或降至绝对值<0.5μg/L，则停用抗生素。抗生素治疗持续时间是主要结局。患者从首次发生脓毒症事件开始随访 28 天。
对于首次发生的脓毒症事件，PCT 组的抗生素平均持续时间为 9.3 天，而对照组的抗生素平均持续时间为 10.9 天 ( = 0.10)。与对照组平均（SD）抗生素无存活天数 3.8（5.22）天相比，干预组的平均（SD）抗生素无存活天数更高，为 7.7（6.57）天，（ = 0.004）。与对照组（30%）相比，干预组的住院死亡率较低（15%），且具有统计学意义（ = 0.045）。
两组抗生素治疗持续时间无显著差异。然而，与对照组相比，PCT 组的抗生素无存活天数更多，住院死亡率更低。
