If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Antibiotic Use in Patients With Ventilator-Associated Pneumonia Is Reduced by Procalcitonin Determination: Presented at ERS By Evelyn Harvey VIENNA, Austria -- September 16, 2009 -- Ventilator-associated pneumonia (VAP) is a significant problem in hospital intensive care units (ICUs), and although long-term antibiotic use has been associated with increased mortality, serum procalcitonin levels can effectively guide antibiotic discontinuation in VAP patients, researchers suggested here at the 19th Annual Congress of the European Respiratory Society (ERS). Current guidelines on VAP treatment recommend de-escalation or discontinuation of antibiotics at 48 or 72 hours, depending on microbiological results, explained Daiana Stolz, MD, University Hospital Basel, Basel, Switzerland in a presentation on September 14. The Procalcitonin for Discontinuation of Antibiotic Therapy in Clinically Diagnosed VAP (ProVAP) study is the first to evaluate procalcitonin, a serum marker of infection, for antibiotic reduction in VAP patients in a multicentre randomised trial setting. Of the 101 patients randomised, 51 underwent daily serum procalcitonin evaluation and 50 were controls. All patients received antibiotic therapy at the discretion of the centre physician and according to standard clinical, laboratory, and radiological indicators. The study protocol recommended de-escalation of antibiotics in the procalcitonin group if serum level were less than 0.5 ng/mL, or had decreased by 80% or more compared with previous values. Baseline characteristics were similar between groups. Patients in the procalcitonin determination group showed a 27% increase in the median number of antibiotic-free days alive at 28 days post randomisation, the study’s primary endpoint, from 9.5 days in the control-group patients to 13 days in the procalcitonin patients (P = .049). In addition, the time to discontinuation of antibiotics was significantly shortened by procalcitonin determination (P = .043; hazard ratio 1.6; 95% confidence interval, 1.02-2.71). The antibiotic-reduction profile showed a significantly higher proportion of VAP patients de-escalating to antibiotic monotherapy at 72 hours with procalcitonin determination than without (P = .008). All of the patients randomised were included in the analysis. There were no differences in length of hospital stay or mortality rate between the 2 groups. Microbiological profiles indicated a variety of acquired and persistent infections in each group. Actual serum procalcitonin levels varied considerably between individuals, leading Dr. Stolz to suggest that the rate of decrease may be a more appropriate indicator than the absolute quantity. Previous studies have shown no differences in clinical outcomes between VAP patients who received 8 versus 15 days of antibiotics. Longer antibiotic treatment also led to higher rates of superinfections with resistant pathogens. These data show that low serum procalcitonin levels are an appropriate indicator for early antibiotic de-escalation in VAP. The use of procalcitonin as a marker of infection could therefore bypass the need for continuation of antibiotic therapy until microbiological results are available and could shorten treatment duration. “It may not be necessary to measure procalcitonin daily -- the rate of decrease could be calculated over days 1 to 4, for instance. This would need to be tested further in trials,” added Dr. Stolz. Funding for this study was provided by the University Hospital, Basel, Switzerland. [Presentation title: Procalcitonin for Antibiotic De-escalation in Ventilator Associated Pneumonia -- A Randomized Study. Abstract 2798]
|
