RT Journal Article
SR Electronic
T1 Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1364
OP 1375
DO 10.1183/09031936.00053209
VO 34
IS 6
A1 D. Stolz
A1 N. Smyrnios
A1 P. Eggimann
A1 H. Pargger
A1 N. Thakkar
A1 M. Siegemund
A1 S. Marsch
A1 A. Azzola
A1 J. Rakic
A1 B. Mueller
A1 M. Tamm
YR 2009
UL http://erj.ersjournals.com/content/34/6/1364.abstract
AB 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.