Use Of Procalcitonin To Shorten Antibiotic Treatment Duration In Patients With Community-acquired Pneumonia

Background: In patients with community-acquired pneumonia,the domestic and foreign guidelines on the duration of antibiotics usage is not clearly defined,recommended mostly "expert consensus", rather than evidence-based medicine. It is not uncommon that clinicians discontinue antibiotics by their experience, resulting in prolonged treatment duration of antibiotics, increase both antibiotic and overall cost, and probably increase the production of bacterial resistance and nosocomial infections. Procalcitonin (PCT) is a sensitive indicator of bacterial infection and is closely related to the disease severity and prognosis of the infection. Whether it can be used as an indicator to guide the duration of antibiotic treatment is not very clear.Objective: A retrospective case-control study was conducted to assess the value of procalcitonin in shortening of antibiotics in patients with community-acquired pneumonia.Methods: A total of 624 patients with community-acquired pneumonia were admitted in the Department of Respiratory Medicine, the First Affiliated Hospital of PLA General Hospital, Sino-Japanese Friendship Hospital,from July 2014 to October 2016. The PCT was measured at first 24 hours of admition and 3,5,7 days in hospital in 202 patients. The PCT value of all 202 enrolled patients were > 0.25 ng /ml at first 24 hours of admition. In 98 patients the antibiotics were discontinued according to the value of PCT (observation group), and 104 patients were not fellow this rule(control group).We choosed the initial antibiotic regimen according to CAP guideline published in Chinese Journal of Tuberculosis and Respiratory Diseases. The two groups were received the same adjuvant therapy, and adjusted the regimen based on bacteria results and clinical efficacy.In the observation group, the antibiotics were used and discontinued guiding by the change of serum PCT value.In the control group, the antibiotics were used and discontinued according to the clinical experience of clinicians and CAP guideline recommendations and the symptoms relieve of the patients. The duration of antibiotic usage, clinical efficiency,hospitalization costs, antibiotic costs, length of stay, 30-day recurrence rates,and mortality were compared between the two groups.Results: The duration of antibiotic usage, the costs of antibiotics and hospitalization,and the days in hospital were decreased significantly in PCT group compared with control group.The efficiency, recurrence and mortality rates had not significant diffeiences between two groups.Conclusion: Discontinuation of antibiotics in patients with community-acquired pneumonia based on value of serum PCT may shorten the duration of antibiotic,without compromise of the efficiency,recurrence rate and mortality.