Point-of-Care Procalcitonin to Guide the Discontinuation of Antibiotic Treatment in the Intensive Care Unit: A Malaysian Randomised Controlled Trial
https://doi.org/10.47836/mjmhs.18.6.10
- Author:
Wan Fadzlina Wan Muhd Shukeri
1
;
Mohd Basri Mat-Nor
2
;
Azrina MD Ralib
2
;
Mohd Zulfakar Mazlan
1
;
Mohd Hasyizan Hassan
1
Author Information
1. Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan
2. Department of Anaesthesiology and Critical Care, Kuliyyah of Medicine, International Islamic Universiti Malaysia, 24200 Kuantan, Pahang
- Publication Type:Journal Article
- Keywords:
Antimicrobial stewardship, Point-of-care, Procalcitonin, Sepsis
- From:Malaysian Journal of Medicine and Health Sciences
2022;18(No.6):65-71
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: This work aims to establish the practicality of simple point-of-care (POC) measurements of procalcitonin (PCT) coupled with the standard PCT-guided antibiotic treatment discontinuation algorithm to guide the
cessation of antibiotic treatment in intensive care unit (ICU). Methods: In this randomised-controlled trial, 80 adult
patients with suspected bacterial infections were randomised to either the POC PCT-guided arm (n = 40) or the standard-of-care arm (n = 40). The decision to discontinue antibiotic treatment in the POC PCT-guided arm was based on
the POC PCT-guided antibiotic-treatment discontinuation strategy, which states that discontinuation is urged once
the PCT concentration has reduced by ≥ 80% or to < 0.5 ng/mL. In the standard-of-care arm, the antibiotic-treatment
duration followed the local guidelines. Results: The median duration of antibiotic treatment was 6.5 [IQR = 5.0-7.0]
days in the POC PCT-guided antibiotic-treatment arm versus 7.5 [IQR = 5.0-14.0] days in the standard-of-care arm
(p = 0.010). The mean antibiotic-free days in the first 30 days after study inclusion was 20.7 (SD = 5.3) days in the
POC PCT-guided antibiotic-treatment arm versus 16.4 (SD = 7.4) days in the standard-of-care arm (p = 0.004). The
number of patients who took an antibiotic for more than 10 days was 2 (5%) in the POC PCT-guided antibiotic-treatment arm versus 13 (32.5%) in the standard-of-care arm (p = 0.002). Conclusion: Antibiotic use in patients with
symptoms of bacterial infections in the ICU was substantially minimised with the installation of a POC PCT-guided
antibiotic-treatment cessation.
- Full text:11.2022my1360.pdf
