Procalcitonin Guided Antibiotic Stewardship in Pediatric Sepsis and Lower Respiratory Tract Infections

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Abstract

Objectives

To determine the impact of procalcitonin-guided antibiotic stewardship protocol (PCT-ASP) in children admitted with sepsis and lower respiratory tract infection on the duration of antibiotic therapy and clinical outcome.

Methods

This was a single-center study involving children with infections treated with antibiotic therapy according to the PCT-ASP as the study group. The control group consisted of children with same age and diagnosis who were treated with antibiotics according to individual unit protocol before the implementation of PCT-ASP. The primary outcome was median duration of antibiotic therapy and hospital stay.

Results

Among 127 patients, 66 were enrolled in the study and 61 in the control group respectively. The median (IQR) PCT values at admission, day 4 and day 6 of antibiotic therapy were 5.59 (61.3), 2.57 (47.35), and 0.35 (0.47) ng/ml respectively, and showed a decreasing trend. All the children in the control group received antibiotics at admission while 12% of children in the study group were not initiated on antibiotics. In the study group, 53% of the children received antibiotics only for three days in the absence of treatment failure. The duration of antibiotics (p = 0.001) and hospital stay (p = 0.03) were less in the study group when compared to the control group.

Conclusions

PCT-ASP reduces the duration of antibiotics and duration of hospital stay without increasing morbidity and mortality.

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前降钙素原指导小儿败血症和下呼吸道感染中的抗生素管理
摘要 目的 探讨脓毒症和下呼吸道感染患儿在降钙素原指导下使用抗生素管理方案(PCT-ASP)对抗生素治疗时间和临床疗效的影响。 方法 这是一项单中心研究,以根据 PCT-ASP 进行抗生素治疗的感染患儿为研究组。对照组由年龄和诊断相同的儿童组成,他们在 PCT-ASP 实施前按照个别单位的方案接受抗生素治疗。主要结果是抗生素治疗和住院时间的中位数。 结果 127 名患者中,研究组 66 人,对照组 61 人。入院时、抗生素治疗第 4 天和第 6 天的 PCT 中位值(IQR)分别为 5.59(61.3)、2.57(47.35)和 0.35(0.47)纳克/毫升,且呈下降趋势。对照组的所有患儿在入院时都接受了抗生素治疗,而研究组有 12% 的患儿没有开始接受抗生素治疗。在研究组中,53%的患儿在没有治疗失败的情况下仅接受了三天的抗生素治疗。与对照组相比,研究组的抗生素使用时间(p = 0.001)和住院时间(p = 0.03)均较短。 结论 PCT-ASP 可缩短抗生素的使用时间和住院时间,但不会增加发病率和死亡率。
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