RESUMEN
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 MAIN RESULTS: 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.
Asunto(s)
Antibacterianos/uso terapéutico , Proteína C-Reactiva/análisis , Calcitonina/sangre , Precursores de Proteínas/sangre , Choque Séptico/tratamiento farmacológico , Anciano , Biomarcadores/sangre , Brasil/epidemiología , Péptido Relacionado con Gen de Calcitonina , Intervalos de Confianza , Femenino , Hospitales Universitarios , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Choque Séptico/sangre , Choque Séptico/mortalidadAsunto(s)
Enfermedades Cardiovasculares/diagnóstico por imagen , Hallazgos Incidentales , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Humanos , Tamizaje Masivo , Neoplasias/diagnóstico por imagenRESUMEN
Sintetiza conhecimentos sobre floraçöes de algas e toxidade em corpos d'água no estado de Säo Paulo, e na literatura mundial. Discute a relaçäo entre eutrofizaçäo e ocorrência dessas floraçöes e enfatiza aspectos da soluçäo do problema