Emilio Maseda1, Alejandro Suarez-de-la-Rica2, Víctor Anillo2, Eduardo Tamayo3, Carlos A García-Bernedo4, Fernando Ramasco5, Maria-Jose Villagran2, Genaro Maggi2, Maria-Jose Gimenez6, Lorenzo Aguilar6, Juan-José Granizo7, Antonio Buño8, Fernando Gilsanz2. 1. Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. Electronic address: emilio.maseda@gmail.com. 2. Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain. 3. Anesthesiology and Surgical Critical Care Department, Hospital Clínico Universitario, Avenida Ramón y Cajal 3, 47005 Valladolid, Spain. 4. Anesthesiology and Surgical Critical Care Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, 08003 Barcelona, Spain. 5. Anesthesiology and Surgical Critical Care Department, Hospital Universitario La Princesa, Diego de Leon 62, 28006 Madrid, Spain. 6. PRISM-AG, Don Ramon de la Cruz 72, 28006 Madrid, Spain. 7. Preventive Medicine Department, Hospital Infanta Cristina, Avenida 9 de junio 2, 28981 Parla, Madrid, Spain. 8. Clinical Analysis Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
Abstract
PURPOSE: 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. CONCLUSION: Procalcitonin guidance produced 50% reduction in antibiotic duration (P < .001, log-rank test).
PURPOSE: 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 shockpatients, 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. CONCLUSION: Procalcitonin guidance produced 50% reduction in antibiotic duration (P < .001, log-rank test).
Authors: Alejandro Suarez-de-la-Rica; Fernando Gilsanz; Emilio Maseda; Philippe Montravers; Sigismond Lasocki; Thomas Lescot; Herve Dupont Journal: Intensive Care Med Date: 2018-04-13 Impact factor: 17.440
Authors: Eric Gluck; H Bryant Nguyen; Kishore Yalamanchili; Margaret McCusker; Jaya Madala; Frank A Corvino; Xuelian Zhu; Robert Balk Journal: PLoS One Date: 2018-10-17 Impact factor: 3.240