Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study.

Détails

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Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_6A0BF96A36EF
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study.
Périodique
European Respiratory Journal
Auteur(s)
Stolz D., Smyrnios N., Eggimann P., Pargger H., Thakkar N., Siegemund M., Marsch S., Azzola A., Rakic J., Mueller B., Tamm M.
ISSN
1399-3003[electronic]
ISSN-L
0903-1936
Statut éditorial
Publié
Date de publication
2009
Peer-reviewed
Oui
Volume
34
Numéro
6
Pages
1364-1375
Langue
anglais
Résumé
In patients with ventilator-associated pneumonia (VAP), guidelines recommend antibiotic therapy adjustment according to microbiology results after 72 h. Circulating procalcitonin levels may provide evidence that facilitates the reduction of antibiotic therapy. In a multicentre, randomised, controlled trial, 101 patients with VAP were assigned to an antibiotic discontinuation strategy according to guidelines (control group) or to serum procalcitonin concentrations (procalcitonin group) with an antibiotic regimen selected by the treating physician. The primary end-point was antibiotic-free days alive assessed 28 days after VAP onset and analysed on an intent-to-treat basis. Procalcitonin determination significantly increased the number of antibiotic free-days alive 28 days after VAP onset (13 (2-21) days versus 9.5 (1.5-17) days). This translated into a reduction in the overall duration of antibiotic therapy of 27% in the procalcitonin group (p = 0.038). After adjustment for age, microbiology and centre effect, the rate of antibiotic discontinuation on day 28 remained higher in the procalcitonin group compared with patients treated according to guidelines (hazard rate 1.6, 95% CI 1.02-2.71). The number of mechanical ventilation-free days alive, intensive care unit-free days alive, length of hospital stay and mortality rate on day 28 for the two groups were similar. Serum procalcitonin reduces antibiotic therapy exposure in patients with ventilator associated pneumonia.
Mots-clé
Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents/administration & dosage, Calcitonin/blood, Female, Guidelines as Topic, Humans, Male, Middle Aged, Pneumonia, Ventilator-Associated/drug therapy, Pneumonia, Ventilator-Associated/microbiology, Proportional Hazards Models, Protein Precursors/blood, Time Factors, Treatment Outcome
Pubmed
Web of science
Open Access
Oui
Création de la notice
06/10/2009 11:05
Dernière modification de la notice
20/08/2019 15:24
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