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Langenbeck's Archives of Surgery

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01-03-2009 | Controlled Prospective Clinical Trials

Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study

Authors: S. Schroeder, M. Hochreiter, T. Koehler, A.-M. Schweiger, B. Bein, F. S. Keck, T. von Spiegel

Published in: Langenbeck's Archives of Surgery | Issue 2/2009

Abstract

Background

Adequate indication and duration of administration are central issues of modern antibiotic treatment in intensive care medicine. The biochemical variable procalcitonin (PCT) is known to indicate systemically relevant bacterial infections with high accuracy. In the present study, we aimed to investigate the clinical usefulness of PCT for guiding antibiotic treatment in surgical intensive care patients with severe sepsis.

Patients and methods

Patients were randomly assigned to a PCT-guided or a control group requiring antibiotic treatment. All patients received a calculated antibiotic regimen according to the presumed microbiological spectrum. In the PCT-guided group, antibiotic treatment was discontinued if clinical signs of infection improved and the PCT value was either <1 ng/ml or decreased to <35% of the initial concentration within three consecutive days. In the control group, antibiotic treatment was directed by empirical rules.

Results

The PCT-guided group (n = 14 patients) and the control group (n = 13 patients) did not differ in terms of biological variables, underlying diseases, and overall disease severity. PCT guidance led to a significant reduction of antibiotic treatment from 6.6 ± 1.1 days (mean ± SD) compared with 8.3 ± 0.7 days in control patients (p < 0.001) along with a reduction of antibiotic treatment costs of 17.8% (p < 0.01) without any adverse effects on outcome.

Conclusions

Monitoring of PCT is a helpful tool for guiding antibiotic treatment in surgical intensive care patients with severe sepsis. This may contribute to an optimized antibiotic regimen with beneficial effects on microbial resistances and costs in intensive care medicine.

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Title: Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study
Authors: S. Schroeder
M. Hochreiter
T. Koehler
A.-M. Schweiger
B. Bein
F. S. Keck
T. von Spiegel
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 2/2009
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-008-0432-1

At a glance: The ONWARDS insulin icodec trials

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Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study

Abstract

Background

Patients and methods

Results

Conclusions

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Abstract

Background

Patients and methods

Results

Conclusions

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