RESUMEN
The purpose of this study was to examine the hypothesis that an algorithm based on serial measurements of procalcitonin (PCT) allows reduction in the duration of antibiotic therapy compared with empirical rules, and does not result in more adverse outcomes in burn patients with infectious complications. All burn patients requiring antibiotic therapy based on confirmed or highly suspected bacterial infections were eligible. Patients were assigned to either a procalcitonin-guided (study group) or a standard (control group) antibiotic regimen. The following variables were analyzed and compared in both groups: duration of antibiotic treatment, mortality rate, percentage of patients with relapse or superinfection, maximum SOFA score (days 1-28), length of ICU and hospital stay. A total of 46 Burn ICU patients receiving antibiotic therapy were enrolled in this study. In 24 patients antibiotic therapy was guided by daily procalcitonin and clinical assessment. PCT guidance resulted in a smaller antibiotic exposure (10.1±4 vs. 15.3±8 days, p=0.034) without negative effects on clinical outcome characteristics such as mortality rate, percentage of patients with relapse or superinfection, maximum SOFA score, length of ICU and hospital stay. The findings thus show that use of a procalcitonin-guided algorithm for antibiotic therapy in the burn intensive care unit may contribute to the reduction of antibiotic exposure without compromising clinical outcome parameters.
Le but de cette étude était d'examiner si un algorithme basé sur des mesures de la procalcitonine (PCT) peut permettre la réduction de la durée de l'antibiothérapie, sans être dangereuse, chez les patients brûlés infectés. Tous les patients brûlés nécessitant une antibiothérapie en raison d'une infection bactérienne très probable ou confirmée étaient éligibles. Les patients ont été divisés en deux groupes: groupe à l'étude (durée de traitement guidé par PCT), et groupe de contrôle (durée selon les préconisations actuelles). Les variables suivantes ont été analysées et comparées: durée de traitement, mortalité, le pourcentage de patients avec une surinfection ou une rechute, score SOFA maximum entre J1 et J28, durées de séjour en soins intensifs et à l'hôpital. Un total de 46 patients, hospitalisés en soins intensifs et recevant une antibiothérapie ont été inclus dans cette étude, dont 24 dans le groupe PCT. Ces patients ont reçu une exposition aux antibiotiques inférieure (10,1 ± 4 vs 15,3 ± 8 jours, p = 0,034), sans effets négatifs sur le taux de mortalité et la durée du séjour à l'hôpital. Les résultats montrent que cette méthode peut contribuer à la réduction de l'utilisation des antibiotiques chez les brûlés en soins intensifs, sans compromettre leur avenir.
RESUMEN
PURPOSE: To investigate brain cancer patients' satisfaction hospitalised in a tertiary care university public hospital in Alexandroupolis, Greece, in order to improve medical, nursing, and organizational-administrative services. METHODS: This cross-sectional study involved 163 patients having been hospitalised for at least 24 hours. The patients were asked to fill in a satisfaction questionnaire previously approved by the Greek Ministry of Health. Four aspects of satisfaction were investigated (medical, hotel accommodation/ organisational facilities, nursing, global). Using Principal Component Analysis, summated scales were formed and tested for internal consistency using Cronbach's alpha coefficient. The non parametric Spearman's rank correlation coefficient was also used and the threshold p-value for statistical significance (2-sided) was set at 0.05. RESULTS: The results revealed a high degree of global satisfaction (73.31%), yet satisfaction was higher for the medical (88.88%) and nursing (84.26%) services. Moreover, satisfaction derived from the accommodation facilities and the general organisation was found to be more limited (74.17%). Statistically significant differences (based on various demographic variables) in the participants' global satisfaction were not observed. On the contrary, self-assessment of health status at admission was negatively correlated with medical (r(s)=-0.157, p=0.045) and nursing (r(s)=-0.168, p=0.032) satisfaction. Greek citizenship contributed to bigger satisfaction scores in the accommodation/organisational facilities dimension (r(s)=0.158, p=0.044). Finally, age was positively linked to nursing satisfaction (r(s)=0.181, p=0.02). CONCLUSION: The present study confirmed in part the results of previously published Greek surveys assessing general patient populations. However, more studies are urgently needed to confirm these findings in a much bigger brain cancer population.
