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Clinical pulmonary infection score and a spot serum procalcitonin level to guide discontinuation of antibiotics in ventilator-associated pneumonia: a study in a single institution with high prevalence of nonfermentative gram-negative bacilli infection

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Issued Date

2018

Resource Type

Article

File Type

application/pdf

ISSN

17534658

DOI

10.1177/1753466618760134

Other identifier(s)

2-s2.0-85054729619

Rights Holder(s)

Scopus

Bibliographic Citation

Therapeutic Advances in Respiratory Disease. Vol 12, No. (2018)

Suggested Citation

Wongsurakiat P., Tulatamakit S. Clinical pulmonary infection score and a spot serum procalcitonin level to guide discontinuation of antibiotics in ventilator-associated pneumonia: a study in a single institution with high prevalence of nonfermentative gram-negative bacilli infection. Therapeutic Advances in Respiratory Disease. Vol 12, No. (2018). doi:10.1177/1753466618760134 Retrieved from: https://hdl.handle.net/20.500.14740/6154

Title

Clinical pulmonary infection score and a spot serum procalcitonin level to guide discontinuation of antibiotics in ventilator-associated pneumonia: a study in a single institution with high prevalence of nonfermentative gram-negative bacilli infection

Author(s)

Wongsurakiat P.
 Tulatamakit S.

Abstract

Background: We wanted to determine the impact of combined Clinical Pulmonary Infection Score (CPIS) and a spot serum procalcitonin (PCT)-guided protocol to shorten the duration of antibiotic treatment in patients with ventilator-associated pneumonia (VAP), mainly caused by nonfermentative gram-negative bacilli (NF-GNB). Methods: Patients with VAP who received appropriate antibiotics for 7 days, temperature ⩽ 37.8°C, without shock, and CPIS ⩽ 6 were allocated to the PCT group or conventional group according to the treating physicians’ decisions. In the PCT group, antibiotics were stopped if the PCT level on day 8 < 0.5 ng/ml. In the conventional group, antibiotics were stopped according to physicians’ discretion. Results: There were 24 patients in the PCT group and 26 patients in the conventional group. NF-GNB were responsible for VAP in 79.2% of the PCT group and 65.4% of the conventional group. PCT group had a greater number of antibiotic-free days alive during the 28 days after VAP onset than the conventional group (14.6 ± 5.4 days versus 5.9 ± 5.7 days, respectively; p <.001). In the multivariate, propensity score-adjusted analysis, the PCT group [coefficient = −9.1 (–12.2 to −6); p <.001] and extrapulmonary infections [coefficient = 6.4 (3.3–9.5); p <.001] were independent predictors of total antibiotic exposure days. There was no relapse in both groups. Meanwhile, 12.5% of the PCT group and 26.9% of the conventional group subsequently developed recurrent VAP compatible with superinfections. Conclusions: CPIS and a spot serum PCT level appeared effective and safe to guide discontinuation of antibiotic treatment in patients with VAP caused by NF-GNB. Trial registration: TCTR20160726002. © The Author(s), 2018.

Subject(s)

Antibiotic agent
 Procalcitonin
 Antiinfective agent
 Biological marker
 Procalcitonin
 Acinetobacter baumannii
 Aged
 Antibiotic therapy
 Article
 Artificial ventilation
 Bacterial superinfection
 Clinical article
 Clinical Pulmonary Infection Score
 Controlled clinical trial
 Controlled study
 Female
 Hormone blood level
 Human
 Klebsiella pneumoniae
 Male
 Methicillin resistant Staphylococcus aureus
 Methicillin susceptible Staphylococcus aureus
 Non-fermenting Gram-negative bacterium
 Prediction
 Priority journal
 Prospective study
 Pseudomonas aeruginosa
 Recurrent infection
 Relapse
 Scoring system
 Stenotrophomonas maltophilia
 Treatment duration
 Ventilator associated pneumonia
 Blood
 Clinical decision making
 Comparative study
 Drug administration
 Drug monitoring
 Epidemiology
 Gram negative infection
 Microbiology
 Middle aged
 Predictive value
 Prevalence
 Procedures
 Thailand
 Time factor
 Treatment outcome
 Ventilator associated pneumonia
 Very elderly
 Aged
 Aged, 80 and over
 Anti-Bacterial Agents
 Biomarkers
 Clinical Decision-Making
 Drug Administration Schedule
 Drug Monitoring
 Female
 Gram-Negative Bacterial Infections
 Humans
 Male
 Middle Aged
 Pneumonia, Ventilator-Associated
 Predictive Value of Tests
 Prevalence
 Procalcitonin
 Prospective Studies
 Thailand
 Time Factors
 Treatment Outcome

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URI

https://hdl.handle.net/20.500.14740/6154

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Scopus: Year 1983-2021

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