Procalcitonin to guide length of antibiotic therapy in surgical intensive care patients

Introduction

The development of resistance by infective bacterial species is an encouragement for us to reconsider the indication and administration of the available antibiotics. Proper recognition of the indication and the correct duration of therapy are particularly important for the use of highly potent substances in intensive care. There has as yet been no clinical chemical parameter that is capable of specifically distinguishing a bacterial infection from a viral or noninfectious inflammatory reaction. It now appears that procalcitonin (PCT) offers this possibility [1–3]. The present study is intended to clarify whether PCT can be used to guide antibiotic therapy in surgical intensive care patients.

Methods

One hundred and ten patients in a surgical intensive care ward receiving antibiotic therapy after confirmed infection or a high-grade suspicion of an infection were enrolled in this study. In 57 of these patients a new decision was reached each day as to whether the antibiotic therapy should be continued after daily PCT determination and clinical judgement. The control group consisted of 53 patients with a standardised duration of antibiotic therapy over 8 days.

Results

Demographic and clinical data are comparable in both groups. In the PCT group, however, the period of antibiotic therapy is significant shorter compared with controls (5.9 ± 1.7 vs 7.9 ± 0.5 days, P < 0.001) without unfavourable effects on clinical outcome.

Conclusion

The daily determination of PCT for intensive care patients shortened the duration of antibiotic therapy. There were no unfavourable effects on the outcome.