Huespe Iván, Prado Eduardo, Staneloni Inés, Contrera Nicolás, Denaday Lisandro, San Roman Eduardo, Sinner Jorge
Terapia Intensiva de Adultos, Hospital Italiano de Buenos Aires, Argentina. E-mail:
Instituto de Medicina Traslacional e Ingeniería Biomédica HIBA-IUHI-CONICET, Argentina.
Medicina (B Aires). 2020;80(6):599-605.
Procalcitonin guidance stimulates a reduction in the duration of antibiotic treatment in critically ill patients with a presumed bacterial infection, but its role in infections caused by multidrug-resistant bacteria has not been sufficiently explored. In this retrospective observational study, we analyzed procalcitonin curves of 32 patients with culture-confirmed ventilation-associated pneumonia (VAP) and catheter-related bloodstream infections (CRBSI) occurred during the period 11/1/2016 to 7/1/2019. Sixteen infections were caused by multidrug-resistant bacteria (10 CRBSI and 6 VAP) and other 16 by sensitive bacteria (10 CRBSI and 6 VAP). CRBSI generated by multidrug-resistant bacteria elicited significantly higher procalcitonin levels than CRBSI infections caused by sensitive bacteria (39 ± 30 υg/l vs. 10.7 ± 11 υg/l, p = 0.02). Patients with VAP caused by sensitive and multidrug-resistant bacteria elicited similar procalcitonin levels. The time to a decrease in procalcitonin level to less than 80% of the peak value or less than 0.5 υg/l upon effective antibiotic treatment was 7.2 ± 2.9 days in multidrug-resistant bacteria vs. 5 ± 1.8 days in sensitive bacteria (p = 0.03). In multidrug-resistant bacteria, the inflammatory response measured by procalcitonin is stronger and longer, even with an effective antibiotic treatment. However, the decline occurs before the conventional antibiotic scheme is completed. The potential application of antibiotic protocols guided by procalcitonin to these groups of patients grants further studies aimed to reduce exposure to antibiotics in critical multidrug-resistant infections.
降钙素原指导可缩短疑似细菌感染的危重症患者的抗生素治疗时长，但它在耐多药细菌所致感染中的作用尚未得到充分探究。在这项回顾性观察研究中，我们分析了2016年11月1日至2019年7月1日期间32例经培养确诊为呼吸机相关性肺炎（VAP）和导管相关血流感染（CRBSI）患者的降钙素原曲线。16例感染由耐多药细菌引起（10例CRBSI和6例VAP），另外16例由敏感细菌引起（10例CRBSI和6例VAP）。耐多药细菌所致CRBSI引发的降钙素原水平显著高于敏感细菌所致CRBSI感染（39±30μg/L vs. 10.7±11μg/L，p = 0.02）。敏感和耐多药细菌所致VAP患者的降钙素原水平相似。有效抗生素治疗后，耐多药细菌感染患者降钙素原水平降至峰值的80%以下或低于0.5μg/L的时间为7.2±2.9天，而敏感细菌感染患者为5±1.8天（p = 0.03）。在耐多药细菌感染中，即使进行了有效的抗生素治疗，通过降钙素原测量的炎症反应仍更强且持续时间更长。然而，炎症反应在传统抗生素治疗方案结束前就会下降。以降钙素原为指导的抗生素方案在这些患者群体中的潜在应用，为旨在减少危重症耐多药感染患者抗生素暴露的进一步研究提供了依据。
