title: Clinical and economic impact of procalcitonin to shorten antimicrobial therapy in septic patients with proven bacterial infection in an intensive care setting.
abstract: Biomarkers such as procalcitonin (PCT) have been studied to guide duration of antibiotic therapy. We aimed to assess whether a decrease in PCT levels could be used to reduce the duration of antibiotic therapy in intensive care unit (ICU) patients with a proven infection without risking a worse outcome. We assessed 265 patients with suspected sepsis, severe sepsis, or septic shock in our ICU. Of those, we randomized 81 patients with a proven bacterial infection into 2 groups: an intervention group in which the duration of the antibiotic therapy was guided by a PCT protocol and a control group in which there was no PCT guidance. In the per-protocol analysis, the median antibiotic duration was 9 days in the PCT group (n = 20) versus 13 days in the non-PCT group (n = 31), P = 0.008. This study demonstrates that PCT can be a useful tool for limiting antimicrobial therapy in ICU patients with documented bacterial infection.
authors.affiliation: Critical Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. deliberato@einstein.br
authors.forename: Rodrigo Octavio
authors.initials: RO
authors.lastname: Deliberato
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Paula Rodrigues
authors.initials: PR
authors.lastname: Sanches
authors.forename: Marines Dalla Valle
authors.initials: MD
authors.lastname: Martino
authors.forename: Carlos Eduardo dos Santos
authors.initials: CE
authors.lastname: Ferreira
authors.forename: Jacyr
authors.initials: J
authors.lastname: Pasternak
authors.forename: Angela Tavares
authors.initials: AT
authors.lastname: Paes
authors.forename: Lilian Moreira
authors.initials: LM
authors.lastname: Pinto
authors.forename: Oscar Fernando Pavão
authors.initials: OF
authors.lastname: dos Santos
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000097:blood* / Q000188:drug therapy / Q000191:economics / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D017046:Cost Savings; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide