[EngO6-6] Open label prospective randomised control study of high cut point level of procalcitonin guided antibiotic therapeutic protocol in surgical critically ill patients
Background: Post operative fever is a common problem. In some situations, to distinguish infection from non - infection is difficult. Procalcitonin is claimed to be beneficial for identifying infection. However, the cut point value is still not concluded especially on post-operative critically ill patient.
Objectives: To show the benefit of efficacy of procalcitonin in post-operative fever in surgically critical ill patients. The cut point of less than 1 ng/ml or below 70% of initial level is used for guiding physician to discontinue antibiotic. The mortality rate and reinfection rate were analyzed.
Material and methods: The open label randomized control study was conducted. One hundred hospitalized patients in surgical intensive care unit, sub surgical intensive care unit and trauma intensive care unit were eligible in this study. The patients were divided into two groups, usual care group (UC) and procalcitonin-guided treatment group (PC).
Results: One hundred patients were included in the study. Baseline characteristics were not statistical significant different between group. Mean antibiotic duration and antibiotic free day were statistical significant different between group [PC vs. UC :8.5 days (IQR 5-17) vs. 14 days(IQR 8-28), (p=0.015); and 18 days(IQR 0-23) vs. 7.5 days(IQR 0-17), (p=0.023) respectively]. 90 day mortality and recurrent infection were not statistical significant different [90 days mortality (12/50) 24% vs. (11/50) 22%, Hazard ratio,HR,(95% confidence interval) 0.91 (0.41-2.03), p=0.818; hospital recurrent infection (14/50) 28% vs. (21/50) 42%, Hazard ratio,HR,(95% confidence interval) 0.62 (0.31-1.21), p=0.161.
Conclusion: The high cut point of procalcitonin level of 1 ng/ml or below 70% of initial level decrease antibiotic usage duration in post-operative surgical critically ill patients without differences on 90 days mortality and hospital re-infection.
Objectives: To show the benefit of efficacy of procalcitonin in post-operative fever in surgically critical ill patients. The cut point of less than 1 ng/ml or below 70% of initial level is used for guiding physician to discontinue antibiotic. The mortality rate and reinfection rate were analyzed.
Material and methods: The open label randomized control study was conducted. One hundred hospitalized patients in surgical intensive care unit, sub surgical intensive care unit and trauma intensive care unit were eligible in this study. The patients were divided into two groups, usual care group (UC) and procalcitonin-guided treatment group (PC).
Results: One hundred patients were included in the study. Baseline characteristics were not statistical significant different between group. Mean antibiotic duration and antibiotic free day were statistical significant different between group [PC vs. UC :8.5 days (IQR 5-17) vs. 14 days(IQR 8-28), (p=0.015); and 18 days(IQR 0-23) vs. 7.5 days(IQR 0-17), (p=0.023) respectively]. 90 day mortality and recurrent infection were not statistical significant different [90 days mortality (12/50) 24% vs. (11/50) 22%, Hazard ratio,HR,(95% confidence interval) 0.91 (0.41-2.03), p=0.818; hospital recurrent infection (14/50) 28% vs. (21/50) 42%, Hazard ratio,HR,(95% confidence interval) 0.62 (0.31-1.21), p=0.161.
Conclusion: The high cut point of procalcitonin level of 1 ng/ml or below 70% of initial level decrease antibiotic usage duration in post-operative surgical critically ill patients without differences on 90 days mortality and hospital re-infection.