Application Of Antibacterial Drugs Directed By Procalcitonin

Purpose and BackgroundNowadays,antibacterial drugs resistance problem increasing seriously,in April 2014,the world health organization(WHO)has released the global antimicrobial resistance monitoring report,warned that "antibacterial drugs after" may soon become a reality in the world.In fact,in some ways,the world of "antibiotic" has arrived.Although our country began antibacterials special rectification activities in 2011,and now the amount of antibacterial drugs of medical institutions has become a substantial decline,However,due to all levels of medical institutions concerned "administrative punishment",often using a fixed target to stimulate clinical departments to reduce the amount of antibacterial drugs,the individual medical institutions even emphasizes that the amount of antimicrobial agents as little as possible,result in insufficient antibiotic therapy treatment in some patients,inadequate dosage increased the risk of bacterial resistance.How to appropriate use of antimicrobial agents is important and difficult for clinical rational.So find a high sensitivity and specificity infection markers to help physicians develop anti-infective programs,both from the prevention of infection and treatment of infections,may have great help in infection treatment.MethodIn healthy human,Procalcitonin(PCT)serum level is extremely low,almost can not be detected,but when there is bacterial infection,PCT levels increased significantly,thus can be used as a diagnostic indicator of bacterial infectious diseases.1.The treatment of serious infection patients,there are a mount of related researches related to procalcitonin,so we conducted a systematic evaluation.Meta-analysis was used to perform quantitative and quantitative analysis of the relevant randomized controlled trials.To compare with the control group,whether the PCT group could shorten the time of antibiotic use,the mortality,ICU treatment days,total length of stay and so on.2.For patients with perioperative prophylaxis,in order to shorten the period of treatment of antibacterial drug use in cardiovascular surgery,we use a randomized controlled trial(RCT)design,random numbers method to divided samples into experimental group and control group.Experimental group(procalcitonin group)calcitonin original get normal postoperatively,and observe it after the experimental group are generally better stop using antibacterial drugs.The control group according to the X-ray no postoperative infection,basic normal body temperature outcome indicators,and observe it after the control group are generally better stop using antibacterial drugs.Compare the therapeutic effect and security of the two groups of patients,and antibacterial drugs consumption times、costs,hospitalization days、costs.Studies the role of Procalcitonin in perioperative use of antibacterial drugs,provide evidence for the formulation of perioperative use of antibacterial drugs standard in our hospital,and provide the gist for specification of antimicrobial drug use.Result1.PCT guided antibiotic use in infected patientsA Meta analysis showed total of 826 cases of patients: Compared with control group,the PCT group of shortened the period of antibacterial drugs use(MD =-2.52,95%CI(-3.07,-1.98,P<0.00001),the treatment of the ICU days[MD=-0.22,95%CI(-1.40,0.96),P=0.72],mortality[OR=1.14,95%CI(0.83,1.56),P=0.42]and total hospitalization time[MD=-1.81,95%CI(-4.37,0.76),P=0.17]had no significant difference.Conclued that with PCT guide,the application of antibacterial drugs can effectively be reduced in sepsis patients,and were safe.2.For patients with perioperative prophylaxisThe data of sex,age,operation type,antibacterial drugs consumption time,hospitalization time,antibacterial drugs costs and total hospitalization costs were analyzed by independent sample T test.There was no significant difference in age、sex and operation type(P> 0.05),there were statistical differences in antibacterial drugs consumption time,drugs costs,hospitalization time,antibacterial drugs consumption time,hospitalization costs between the two groups(P<0.05).The results showed that antibacterial drugs consumption time was reduced according to treatments that PCT guided.Conclusion1.The Meta-analysis of the use of PCT guided antibacterial drugs use in infected patients shown that,PCT guided antibacterial drugs therapies in patients with sepsis can effectively reduce the antibacterial drugs application and were safe.2.In the randomized controlled trials,with PCT guided perioperative antibacterial drugs use in the Cardiovascular Surgery,the trial group reduced the duration of antibiotics administration compared to the control group.