ABSTRACT
The purpose of this study was to examine the hypothesis that an algorithm based on serial measurements of procalcitonin (PCT) allows reduction in the duration of antibiotic therapy compared with empirical rules, and does not result in more adverse outcomes in burn patients with infectious complications. All burn patients requiring antibiotic therapy based on confirmed or highly suspected bacterial infections were eligible. Patients were assigned to either a procalcitonin-guided (study group) or a standard (control group) antibiotic regimen. The following variables were analyzed and compared in both groups: duration of antibiotic treatment, mortality rate, percentage of patients with relapse or superinfection, maximum SOFA score (days 1-28), length of ICU and hospital stay. A total of 46 Burn ICU patients receiving antibiotic therapy were enrolled in this study. In 24 patients antibiotic therapy was guided by daily procalcitonin and clinical assessment. PCT guidance resulted in a smaller antibiotic exposure (10.1±4 vs. 15.3±8 days, p=0.034) without negative effects on clinical outcome characteristics such as mortality rate, percentage of patients with relapse or superinfection, maximum SOFA score, length of ICU and hospital stay. The findings thus show that use of a procalcitonin-guided algorithm for antibiotic therapy in the burn intensive care unit may contribute to the reduction of antibiotic exposure without compromising clinical outcome parameters.
Le but de cette étude était d'examiner si un algorithme basé sur des mesures de la procalcitonine (PCT) peut permettre la réduction de la durée de l'antibiothérapie, sans être dangereuse, chez les patients brûlés infectés. Tous les patients brûlés nécessitant une antibiothérapie en raison d'une infection bactérienne très probable ou confirmée étaient éligibles. Les patients ont été divisés en deux groupes: groupe à l'étude (durée de traitement guidé par PCT), et groupe de contrôle (durée selon les préconisations actuelles). Les variables suivantes ont été analysées et comparées: durée de traitement, mortalité, le pourcentage de patients avec une surinfection ou une rechute, score SOFA maximum entre J1 et J28, durées de séjour en soins intensifs et à l'hôpital. Un total de 46 patients, hospitalisés en soins intensifs et recevant une antibiothérapie ont été inclus dans cette étude, dont 24 dans le groupe PCT. Ces patients ont reçu une exposition aux antibiotiques inférieure (10,1 ± 4 vs 15,3 ± 8 jours, p = 0,034), sans effets négatifs sur le taux de mortalité et la durée du séjour à l'hôpital. Les résultats montrent que cette méthode peut contribuer à la réduction de l'utilisation des antibiotiques chez les brûlés en soins intensifs, sans compromettre leur avenir.
ABSTRACT
OBJECTIVE: To evaluate the diagnostic and prognostic performance of inflammatory markers for septic and non septic (localized) bacterial infections in patients with severe burn. METHODS AND RESULTS: Data of 145 patients were prospectively included in this study. Serum procalcitonin and other inflammatory markers were measured within 24 h after burn and daily thereafter. Maximum procalcitonin (p=0.004) was independent predictors of outcome in logistic regression analysis. PCT thresholds of 1.5 ng/ml, 0.52 ng/ml and 0.56 ng/ml had adequate sensitivity and specificity to diagnose sepsis, respiratory tract and wound infections respectively. A threshold value of 7.8 ng/ml in PCT concentration on day 3 was associated with the effectiveness of the sepsis treatment with an AUC of 0.86 (95% CI 0.69-1.03, p=0.002). C-reactive protein levels and WBCs showed no significant change over the first 3 days in the patients with successfully treated sepsis (p=0.93). CONCLUSION: The maximum procalcitonin level has prognostic value in burn patients. PCT can be used as a diagnostic tool in patients with infectious complications with or without bacteremia during ICU stay. Daily consecutive PCT measurements may be a valuable tool in monitoring the effectiveness of antibiotic therapy in burn ICU patients.