Point-of-care procalcitonin guidance to reduce antibiotic use in critically ill patients: a randomized controlled trial
Introduction: Antibiotic therapy is of great importance in sepsis but prolonged duration can add to the emergence of antibiotic resistance. We aimed to examine whether point-of-care (POC) procalcitonin (PCT) guidance can safely reduce the duration of antibiotic use in infected cri...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Kulliyyah of Medicine, International Islamic University Malaysia
2018
|
| Subjects: | |
| Online Access: | http://irep.iium.edu.my/82593/ http://irep.iium.edu.my/82593/1/890-Manuscript-2323-1-10-20200205_point%20of%20care%20PCT.pdf |
| _version_ | 1848789326093090816 |
|---|---|
| author | Wan Muhd Shukeri, Wan Fadzlina Md Ralib, Azrina Mat Nor, Mohd Basri |
| author_facet | Wan Muhd Shukeri, Wan Fadzlina Md Ralib, Azrina Mat Nor, Mohd Basri |
| author_sort | Wan Muhd Shukeri, Wan Fadzlina |
| building | IIUM Repository |
| collection | Online Access |
| description | Introduction: Antibiotic therapy is of great importance in sepsis but prolonged duration can add to the emergence of antibiotic resistance. We aimed to examine whether point-of-care (POC) procalcitonin (PCT) guidance can safely reduce the duration of antibiotic use in infected critically ill patients. Materials and Methods: Eighty adult patients admitted to or acquired sepsis in the intensive care unit (ICU) were enrolled in this randomized controlled trial. Patients were allocated to either POC PCT-guided intervention arm (n=40) or the control arm, in which antibiotic therapy followed local guidelines (n=40). In the PCT-guided arm, antibiotic treatment was discontinued if clinical signs of infection improved and the PCT concentration decreased by >80% of its peak value, or when it reaches a value of <0·5 g/L. Results: The mean duration of antibiotic use for PCT arm was 6.4 (SD 2.3) days compared to 9 (SD 4.3) days in the control arm (p=0.004). In the first 30 days after being assigned to a group, the proportion of patients who received a repeated course of systemic antibiotics was 33% in the PCT arm vs 38.1% in the control arm (p=0.757). Mean length of stay in the ICU was 8.4 (SD 5.3) days in the PCT arm vs 10.4 (SD 12.3) days in the control arm (p=0.404). Mortality at 30 days was 22.5% in the PCT-arm vs 25% in the control arm (p<0.0001). Conclusion: POC PCT guidance stimulates reduction of duration of antibiotic use in ICU, accompanied by a significant decrease in mortality |
| first_indexed | 2025-11-14T17:54:56Z |
| format | Article |
| id | iium-82593 |
| institution | International Islamic University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T17:54:56Z |
| publishDate | 2018 |
| publisher | Kulliyyah of Medicine, International Islamic University Malaysia |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | iium-825932020-09-02T06:27:00Z http://irep.iium.edu.my/82593/ Point-of-care procalcitonin guidance to reduce antibiotic use in critically ill patients: a randomized controlled trial Wan Muhd Shukeri, Wan Fadzlina Md Ralib, Azrina Mat Nor, Mohd Basri RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid Introduction: Antibiotic therapy is of great importance in sepsis but prolonged duration can add to the emergence of antibiotic resistance. We aimed to examine whether point-of-care (POC) procalcitonin (PCT) guidance can safely reduce the duration of antibiotic use in infected critically ill patients. Materials and Methods: Eighty adult patients admitted to or acquired sepsis in the intensive care unit (ICU) were enrolled in this randomized controlled trial. Patients were allocated to either POC PCT-guided intervention arm (n=40) or the control arm, in which antibiotic therapy followed local guidelines (n=40). In the PCT-guided arm, antibiotic treatment was discontinued if clinical signs of infection improved and the PCT concentration decreased by >80% of its peak value, or when it reaches a value of <0·5 g/L. Results: The mean duration of antibiotic use for PCT arm was 6.4 (SD 2.3) days compared to 9 (SD 4.3) days in the control arm (p=0.004). In the first 30 days after being assigned to a group, the proportion of patients who received a repeated course of systemic antibiotics was 33% in the PCT arm vs 38.1% in the control arm (p=0.757). Mean length of stay in the ICU was 8.4 (SD 5.3) days in the PCT arm vs 10.4 (SD 12.3) days in the control arm (p=0.404). Mortality at 30 days was 22.5% in the PCT-arm vs 25% in the control arm (p<0.0001). Conclusion: POC PCT guidance stimulates reduction of duration of antibiotic use in ICU, accompanied by a significant decrease in mortality Kulliyyah of Medicine, International Islamic University Malaysia 2018-12-14 Article PeerReviewed application/pdf en http://irep.iium.edu.my/82593/1/890-Manuscript-2323-1-10-20200205_point%20of%20care%20PCT.pdf Wan Muhd Shukeri, Wan Fadzlina and Md Ralib, Azrina and Mat Nor, Mohd Basri (2018) Point-of-care procalcitonin guidance to reduce antibiotic use in critically ill patients: a randomized controlled trial. IIUM Medical Journal Malaysia, 17 (Supp 1). p. 26. ISSN 1823-4631 https://journals.iium.edu.my/kom/index.php/imjm/article/view/890 |
| spellingShingle | RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid Wan Muhd Shukeri, Wan Fadzlina Md Ralib, Azrina Mat Nor, Mohd Basri Point-of-care procalcitonin guidance to reduce antibiotic use in critically ill patients: a randomized controlled trial |
| title | Point-of-care procalcitonin guidance to reduce antibiotic use in critically ill patients: a randomized controlled trial |
| title_full | Point-of-care procalcitonin guidance to reduce antibiotic use in critically ill patients: a randomized controlled trial |
| title_fullStr | Point-of-care procalcitonin guidance to reduce antibiotic use in critically ill patients: a randomized controlled trial |
| title_full_unstemmed | Point-of-care procalcitonin guidance to reduce antibiotic use in critically ill patients: a randomized controlled trial |
| title_short | Point-of-care procalcitonin guidance to reduce antibiotic use in critically ill patients: a randomized controlled trial |
| title_sort | point-of-care procalcitonin guidance to reduce antibiotic use in critically ill patients: a randomized controlled trial |
| topic | RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid |
| url | http://irep.iium.edu.my/82593/ http://irep.iium.edu.my/82593/ http://irep.iium.edu.my/82593/1/890-Manuscript-2323-1-10-20200205_point%20of%20care%20PCT.pdf |