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。