Procalcitonin-guided antibiotics in severe sepsis 英文参考文献.docVIP

Available online /content/12/6/309 Journal club critique Open Access Vol 12 No 6 Procalcitonin-guided antibiotics in severe sepsis Peter Simon1, Eric B Milbrandt2 and Lillian L Emlet2 1Clinical Fellow, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA 2Assistant Professor, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Corresponding author: Peter Simon, Published: 4 Dec 2008 Critical Care 2008, 12:309 (doi:10.1186/cc7124) This article is online at: /content/12/6/309 ? 2008 BioMed Central Ltd Article details Intervention Evidence-Based Medicine Journal Club EBM Journal Club SectionEric B Milbrandt Expanded Abstract Citation Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J: Use of pro- calcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 2008, 177: 498–505 [1]. All patients had circulating PCT levels drawn daily. In patients randomly assigned to the intervention group, antibiotics were stopped when PCT levels had decreased 90% or more from the initial value (if clinicians agreed) but not before Day 3 (if baseline PCT levels were 1 mg/L) or Day 5 (if baseline PCT levels were 1 mg/L). In control patients, clinicians decided on the duration of antibiotic therapy based on empirical rules. Outcome Background Systemic antibiotic exposure, measured using three variables: 1) duration of antibiotic treatment, 2) antibiotic exposure days per 1000 inpatient days, and 3) days alive without antibiotics within the 28-day follow-up period. The duration of antibiotic therapy in critically ill patients with sepsis can result in antibiotic overuse, increasing the risk of developing bacterial resistance. Procalcitonin (PCT)-guided antibiotic use reduces antibiotic exposure in community- acquired pneumonia. Whether it might