title: Procalcitonin-guided therapy may reduce length of antibiotic treatment in intensive care unit patients with secondary peritonitis: A multicenter retrospective study.
abstract: OBJECTIVE
  Because procalcitonin (PCT) might be surrogate for antimicrobial discontinuation in general intensive care units (ICUs), this study explored its use for secondary peritonitis in 4 surgical ICUs (SICUs).
  
  
  METHODS
  A retrospective study including all consecutive patients with secondary peritonitis, controlled infection source, requiring surgery, and at least 48-hour SICU admission was performed (June 2012-June 2013). Patients were divided following notations in medical records into PCT-guided (notation of PCT-based antibiotic discontinuation) and non-PCT-guided (no notation) groups.
  
  
  RESULTS
  A total of 121 patients (52 PCT-guided, 69 non-PCT-guided) were included. No differences in clinical scores, biomarkers, or septic shock (30 [57.7%] PCT-guided vs 40 [58.0%] non-PCT-guided) were found. Length of intra-SICU (median, 5.0 days; both groups) or in-hospital (median, 20.0 vs 17.5 days) stay, and mortality intra-SICU (9.6% vs 13.0%), 28-day (15.4% vs 20.3%), or in-hospital (19.2% vs 29.0%) were not significantly different (PCT-guided vs non-PCT-guided). In septic shock patients, no mortality differences were found (PCT-guided vs non-PCT-guided): 16.7% vs 22.5% (intra-SICU), 26.7% vs 32.5% (28-day), and 33.3% vs 42.5% (in-hospital). Treatment was shorter in the PCT-guided group (5.1 ±2.1 vs 10.2 ± 3.7 days, P < .001), without differences between patients with and without septic shock.
  
  
  CONCLUSIONS
  Procalcitonin guidance produced 50% reduction in antibiotic duration (P < .001, log-rank test).
authors.affiliation: Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. Electronic address: emilio.maseda@gmail.com.
authors.forename: Emilio
authors.initials: E
authors.lastname: Maseda
authors.affiliation: Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Suarez-de-la-Rica
authors.affiliation: Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Anillo
authors.affiliation: Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario, Avenida Ramón y Cajal 3, 47005 Valladolid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Tamayo
authors.affiliation: Anesthesiology and Surgical Critical Care Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003 Barcelona, Spain.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: García-Bernedo
authors.affiliation: Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Princesa, Diego de Leon 62, 28006 Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Ramasco
authors.affiliation: Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Villagran
authors.affiliation: Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
authors.forename: Genaro
authors.initials: G
authors.lastname: Maggi
authors.affiliation: PRISM-AG, Don Ramon de la Cruz 72, 28006 Madrid, Spain.
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Gimenez
authors.affiliation: PRISM-AG, Don Ramon de la Cruz 72, 28006 Madrid, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Aguilar
authors.affiliation: Preventive Medicine Department, Hospital Infanta Cristina, Avenida 9 de junio 2, 28981 Parla, Madrid, Spain.
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Granizo
authors.affiliation: Clinical Analysis Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Buño
authors.affiliation: Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gilsanz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D015415:Biomarkers; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003422:Critical Care; D005260:Female; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000097:blood / Q000188:drug therapy*; D011498:Protein Precursors / Q000097:blood*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: Antibiotic treatment duration; Complicated intra-abdominal infection; Procalcitonin; Septic shock