Procalcitonin versus C-reactive protein for guiding antibiotic therapy in sepsis: a randomized trial.
Crit Care Med
; 41(10): 2336-43, 2013 Oct.
Article
em En
| MEDLINE
| ID: mdl-23921272
ABSTRACT
OBJECTIVE:
We sought to evaluate whether procalcitonin was superior to C-reactive protein in guiding antibiotic therapy in intensive care patients with sepsis.DESIGN:
Randomized open clinical trial.SETTING:
Two university hospitals in Brazil. PATIENTS Patients with severe sepsis or septic shock.INTERVENTIONS:
Patients were randomized in two groups the procalcitonin group and the C-reactive protein group. Antibiotic therapy was discontinued following a protocol based on serum levels of these markers, according to the allocation group. The procalcitonin group was considered superior if the duration of antibiotic therapy was at least 25% shorter than in the C-reactive protein group. For both groups, at least seven full-days of antibiotic therapy were ensured in patients with Sequential Organ Failure Assessment greater than 10 and/or bacteremia at inclusion, and patients with evident resolution of the infectious process had antibiotics stopped after 7 days, despite biomarkers levels. MEASUREMENTS AND MAINRESULTS:
Ninety-four patients were randomized 49 patients to the procalcitonin group and 45 patients to the C-reactive protein group. The mean age was 59.8 (SD, 16.8) years. The median duration of antibiotic therapy for the first episode of infection was 7.0 (Q1-Q3, 6.0-8.5) days in the procalcitonin group and 6.0 (Q1-Q3, 5.0-7.0) days in the C-reactive protein group (p=0.13), with a hazard ratio of 1.206 (95% CI, 0.774-1.3; p=0.13). Overall, protocol overruling occurred in only 13 (13.8%) patients. Twenty-one patients died in each group (p=0.836).CONCLUSIONS:
C-reactive protein was as useful as procalcitonin in reducing antibiotic use in a predominantly medical population of septic patients, causing no apparent harm.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Precursores de Proteínas
/
Choque Séptico
/
Proteína C-Reativa
/
Calcitonina
/
Antibacterianos
Idioma:
En
Ano de publicação:
2013
Tipo de documento:
Article