Can follow-up procalcitonin measurements shorten the periods of antibiotic administrations for septic patients?

Introduction

To examine whether we can safely shorten the periods of antibiotic administration for septic patients with procalcitonin (PCT) measurements compared with no PCT measurements.

Methods

The participants were septic patients including (1) hospitalized to our ICU from February 2009 to November 2009, (2) administered antibiotics for 4 days and over, and (3) stopped the antibiotics during their ICU stays. We treated the patients from February to June without PCT measurements (Group A). On the other hand, we treated the patients from July to November referring to serum PCT level (Group B). In group B, when the serum PCT level decreases under 0.5 ng/ml, we stopped the antibiotic administrations if their systemic conditions were getting better.

Results

Twelve patients were in Group A, and 15 patients were in Group B. The ages were 65 ± 18 in Group A, and 64 ± 23 in Group B. The APACHE II scores were 20.4 ± 6.3 in Group A, and 18.5 ± 7.5 in Group B. There were no significant differences. The periods of antibiotic administrations were 14.1 ± 7.7 days in Group A, and 9.7 ± 6.0 days in Group B. The periods in Group B tended to be significantly shorter than in Group A (P = 0.049). The C-reactive protein (CRP) levels were 3.5 ± 4.2 mg/dl in Group A, and 6.5 ± 4.1 in Group B when the antibiotic administrations were stopped. The CRP levels in Group B were higher than in Group A (P = 0.071). Two patients in Group B were repeated antibiotic administrations, while they were discharged without any complications.

Conclusions

The follow-up PCT measurements safely shorten the periods of antibiotic administrations for septic patients. We believe that PCT has good cost-benefit effects for critically ill patients.