doiSerbia

Procalcitonin-based therapeutic strategy to reduce antibiotic use in patients after cardiac surgery: A randomized controlled trial

Maravić-Stojković Vera (Imunološka laboratorija, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Laušević-Vuk Ljiljana (Klinika za anesteziju i intenzivnu negu, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Jović Miomir (Klinika za anesteziju i intenzivnu negu, Institut za kardiovaskularne bolesti „Dedinje”, Beograd + Medicinski fakultet, Beograd)
Ranković Aleksandra (Klinika za anesteziju i intenzivnu negu, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Borzanović Milorad (Odsek za kardiologiju, Institut za kardiovaskularne bolesti „Dedinje”, Beograd)
Marinković Jelena (Institut za medicinsku statistiku i informatiku, Medicinski fakultet, Beograd)

Introduction. Procalcitonin (PCT) is a thyroid gland prohormone, and its serum concentration is elevated in systemic bacterial infections. The diagnostic cut-off value of PCT in patients early after cardiac surgery remains unclear. Objective. We investigated whether procalcitonin-guidance could reduce antibiotic usage safely. Methods. The prospective study included 205 patients who underwent open heart surgery. The patients were randomly assigned for procalcitonin-guided antibiotic treatment (PCT-group; n=102) or standard care (standard group; n=103). On the basis of serum procalcitonin concentrations, usage of antibiotics was encouraged (PCT≥0.5 ng/mL) or discouraged. Results. A relative risk of antibiotic exposure in the standard group compared with the PCT-group was 3.81 (95% CI=2.03-7.17; p<0.0001). The mean cost of antibiotics per patient in procalcitonin group was €193.3±636.6 vs. €372.1±841.1 (p=0.206) in the standard group, while the mean cost per hospital day was €8.0±18.4 vs. €17.8±36.3 (p=0.028). We found that non-infectious complications occurred in 40/102 vs. 41/103 (p=0.592) while infections appeared in 5/102 vs. 22/103 (p=0.001) cases. A statistically significant difference was observed in the treatment of urinary infections between PCT-group and standard group; 1/102 vs. 9/103 (p=0.016). In the PCT-group, the ICU stay was 5.74±11.49 days and in the standard group 6.97±11.61 (p=0.812). The hospital stay was 12.08±11.28 vs. 12.93±10.73 (p>0.05) days, respectively. Mortality rates were equal in both groups of patients (p=0.537). Conclusion. Procalcitonin-guided antibiotic treatment is safe and can significantly reduce the cost of postoperative care. Additionally, the antibiotic use during immediate postoperative course should be timely controlled and limited to documented bacterial infections.

Keywords: procalcitonin, antibiotics, inflammatory mediators, cardiac surgery