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Anaesthesiology Intensive Therapy
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3/2021
vol. 53
 
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abstract:
Original paper

Efficacy and safety of the point-of-care procalcitonin test for determining the antibiotic treatment duration in patients with ventilator-associated pneumonia in the intensive care unit: a randomised controlled trial

Mohd Z. Mazlan
1
,
Mohd A.H. Ismail
1
,
Saedah Ali
1
,
Zeti N. Salmuna
2
,
Wan F. Wan Muhd Shukeri
1
,
Mahamarowi Omar
1

1.
Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
2.
Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
Anaesthesiol Intensive Ther 2021; 53, 3: 207–214
Online publish date: 2021/04/12
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Introduction
This study was conducted to assess the efficacy of point-of-care (POC) procalcitonin (PCT) serial measurement in determining the antibiotic treatment duration in patients with ventilator-associated pneumonia (VAP).

Material and methods
One hundred patients were randomly recruited and then further randomly divided into two groups of 50 patients each. The first group used the POC PCT test along with the standard sepsis parameter monitoring, while the second group had the standard monitoring only (C-reactive protein [CRP] level, total white count, temperature and tracheal aspirate culture). Serial PCT test results and CRP levels were monitored on days 1, 3, 7 and 9. The patients were followed up for 28-day mortality.

Results
Eighty-five patients completed the trial, of whom 43 were in the PCT group and 42 were in the control group. The PCT group had a significantly lower mean (SD) antibiotic treatment duration (10.28 [2.68] days) than the control group (11.52 [3.06]). The mean (SD) difference was −1.25 (95% confidence interval [CI], −2.48 to 0.01; t-statistic [df] = −1.997 [83]; P = 0.049). The PCT group also had a higher number of antibiotic-free days alive during the 28 days after VAP onset than the control group (mean [SD], 10.79 [7.61] vs. 8.72 [6.41]). The Sequential Organ Failure Assessment score was the sole factor for the decrease in duration after VAP onset (regression coefficient β [95% CI], −0.70 [−1.19 to −0.20]; P = 0.006).

Conclusions
The POC procalcitonin test can reduce the antibiotic treatment duration in patients with VAP.

keywords:

procalcitonin, point-of-care, clinical pulmonary infection score, C-reactive protein, ventilator-associated pneumonia

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