Point-of-care procalcitonin to guide the discontinuation of antibiotic treatment in the intensive care unit: a Malaysian randomised controlled trial
Introduction: This work aims to establish the practicality of simple point-of-care (POC) measurements of procalcitonin (PCT) coupled with the standard PCT-guided antibiotic treatment discontinuation algorithm to guide the cessation of antibiotic treatment in intensive care unit (ICU). Methods: In t...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | en en |
| Published: |
Faculty of Medicine and Health Sciences
2022
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/101596/7/101596_Point-of-Care%20Procalcitonin%20to%20guide%20the%20discontinuation%20of%20antibiotic.pdf http://irep.iium.edu.my/101596/13/101596_Point-of-care%20procalcitonin%20to%20guide%20the%20discontinuation%20of%20antibiotic_Scopus.pdf http://irep.iium.edu.my/101596/ https://medic.upm.edu.my/upload/dokumen/2022112909262209_MJMHS_1020.pdf |
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| Summary: | Introduction: This work aims to establish the practicality of simple point-of-care (POC) measurements of procalcitonin (PCT) coupled with the standard PCT-guided antibiotic treatment discontinuation algorithm to guide the
cessation of antibiotic treatment in intensive care unit (ICU). Methods: In this randomised-controlled trial, 80 adult
patients with suspected bacterial infections were randomised to either the POC PCT-guided arm (n = 40) or the standard-of-care arm (n = 40). The decision to discontinue antibiotic treatment in the POC PCT-guided arm was based on
the POC PCT-guided antibiotic-treatment discontinuation strategy, which states that discontinuation is urged once
the PCT concentration has reduced by ≥ 80% or to < 0.5 ng/mL. In the standard-of-care arm, the antibiotic-treatment
duration followed the local guidelines. Results: The median duration of antibiotic treatment was 6.5 [IQR = 5.0-7.0]
days in the POC PCT-guided antibiotic-treatment arm versus 7.5 [IQR = 5.0-14.0] days in the standard-of-care arm
(p = 0.010). The mean antibiotic-free days in the first 30 days after study inclusion was 20.7 (SD = 5.3) days in the
POC PCT-guided antibiotic-treatment arm versus 16.4 (SD = 7.4) days in the standard-of-care arm (p = 0.004). The
number of patients who took an antibiotic for more than 10 days was 2 (5%) in the POC PCT-guided antibiotic-treatment arm versus 13 (32.5%) in the standard-of-care arm (p = 0.002). Conclusion: Antibiotic use in patients with
symptoms of bacterial infections in the ICU was substantially minimised with the installation of a POC PCT-guided
antibiotic-treatment cessation. |
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