Medical News Stories
Procalcitonin Usefulness for the Initiation of Antibiotic Treatment in Intensive Care Unit Patients
Study Question: Does a procalcitonin guided strategy (PCT) for the decision to treat infection reduce antibiotic consumption?
Methods: This is a single-center, randomized, prospective study from April-Dec 2008. Patients > 18 years of age and hospitalized > 2 days in an ICU were randomized to PCT or control (physician was blinded to PCT result. The primary endpoint was the difference in antibiotic consumption between groups. Secondary endpoints included: usefulness of PCT in ICU diagnostic algorithms and determination of concordance of infection diagnostic ratings by the ICU physician and an ID specialist blinded to PCT results.
Results: There were 509 patients eligible for the study with no statistically significant differences in baseline characteristics. Neither antibiotic consumption between PCT and control, nor median defined daily dose (DDD)/100 ICU days differed significantly between groups. No difference in the decision to treat by PCT result was found among the groups.
Conclusions: Using a PCT to determine appropriateness of initiation of antibiotics did not lower antibiotic consumption, nor did it improve the accuracy of diagnosis by ICU clinicians.
Perspective: This study suggests that PCT is not a reliable marker of infection, however they did not use serial PCT throughout antibiotic course to guide decision-making, which has been suggested to reduce consumption in other studies. The benefit and cost-effectiveness of this approach requires further study in a multi-center design.