Clinical pulmonary infection score and a spot serum procalcitonin level to guide discontinuation of antibiotics in ventilator-associated pneumonia: a study in a single institution with high prevalence of nonfermentative gram-negative bacilli infection.

临床肺部感染评分和点血清降钙素原水平指导呼吸机相关性肺炎抗生素停药 ： 一项在非发酵革兰阴性杆菌感染高发的单一机构的研究。

• 影响指数: 5.158
• 发表时间: Jan-Dec 2018
• 来源期刊: Ther Adv Respir Dis
• DOI: 10.1177/1753466618760134
• PMID: 29506460
• 文章类型: Comparative Study
• 中科院分区: Q4
• 方向: 医学
• 作者列表: Wongsurakiat P,Tulatamakit S

关键词: antibiotic discontinuation; clinical pulmonary infection score; mechanical ventilation; nonfermentative gram-negative bacilli; procalcitonin; ventilator-associated pneumonia

Mesh: Aged; Aged, 80 and over; Anti-Bacterial Agents / administration & dosage adverse effects; Biomarkers / blood; Clinical Decision-Making; Drug Administration Schedule; Drug Monitoring / methods; Female; Gram-Negative Bacterial Infections / blood diagnosis drug therapy microbiology; Humans; Male; Middle Aged; Pneumonia, Ventilator-Associated / blood diagnosis drug therapy microbiology; Predictive Value of Tests; Prevalence; Procalcitonin / blood; Prospective Studies; Thailand / epidemiology; Time Factors; Treatment Outcome

Abstract

Background We wanted to determine the impact of combined Clinical Pulmonary Infection Score (CPIS) and a spot serum procalcitonin (PCT)-guided protocol to shorten the duration of antibiotic treatment in patients with ventilator-associated pneumonia (VAP), mainly caused by nonfermentative gram-negative bacilli (NF-GNB). Methods Patients with VAP who received appropriate antibiotics for 7 days, temperature ⩽ 37.8°C, without shock, and CPIS ⩽ 6 were allocated to the PCT group or conventional group according to the treating physicians\' decisions. In the PCT group, antibiotics were stopped if the PCT level on day 8 < 0.5 ng/ml. In the conventional group, antibiotics were stopped according to physicians\' discretion. Results There were 24 patients in the PCT group and 26 patients in the conventional group. NF-GNB were responsible for VAP in 79.2% of the PCT group and 65.4% of the conventional group. PCT group had a greater number of antibiotic-free days alive during the 28 days after VAP onset than the conventional group (14.6 ± 5.4 days versus 5.9 ± 5.7 days, respectively; p <.001). In the multivariate, propensity score-adjusted analysis, the PCT group [coefficient = -9.1 (-12.2 to -6); p <.001] and extrapulmonary infections [coefficient = 6.4 (3.3-9.5); p <.001] were independent predictors of total antibiotic exposure days. There was no relapse in both groups. Meanwhile, 12.5% of the PCT group and 26.9% of the conventional group subsequently developed recurrent VAP compatible with superinfections. Conclusions CPIS and a spot serum PCT level appeared effective and safe to guide discontinuation of antibiotic treatment in patients with VAP caused by NF-GNB.
TCTR20160726002.

摘要

背景：我们想确定联合临床肺部感染评分（CPIS）和点血清降钙素原（PCT）指导方案对缩短呼吸机相关性肺炎（VAP）患者抗生素治疗持续时间的影响。主要由非发酵革兰阴性杆菌（NF-GNB）引起。方法VAP患者接受适当抗生素治疗7天,温度37.8°C，没有震惊，根据治疗医师的决定，将CPIS6分配到PCT组或常规组。在PCT组中，如果第8天PCT水平<0.5ng/ml，则停用抗生素。在常规组中,根据医生的判断，抗生素被停用。结果PCT组24例,常规组26例。NF-GNB在PCT组中占79.2％，在常规组中占65.4％。与常规组相比，PCT组在VAP发病后28天内无抗生素存活天数更多（14.6±5.4天对5.9±5.7天，分别；p<.001）。在多变量中，倾向得分调整分析，PCT组[系数=-9.1(-12.2至-6);p<.001]和肺外感染[系数=6.4(3.3-9.5);p<.001]是抗生素总暴露天数的独立预测因子.两组均无复发。同时,PCT组的12.5％和常规组的26.9％随后发生了与重复感染相容的复发性VAP。结论CPIS和局部血清PCT水平可有效、安全地指导NF-GNB所致VAP患者停用抗生素治疗。
TCTR20160726002。