Procalcitonin-Guided Therapy Significantly Reduces Antibiotics Duration

Procalcitonin-guided antibiotic therapy is safe for individuals with ventilator-associated pneumonia (VAP), new research shows. And doing so will reduce antibiotics duration, according to the study authors. 

To conduct their 5-year prospective cohort study, the researchers identified patients with microbiologically proven VAP who had stopped antibiotic therapy before mortality or discharge (N = 157).

The following algorithm was established as a guide for the study: antibiotic therapy withdrawal is strongly encouraged if the patient’s procalcitonin level is less than 0.5 ng/mL or less than 80.0% peak value.

The participants were assigned into one of two groups: those who had stopped antibiotic therapy in accordance with the algorithm (procalcitonin-guided group), or those who discontinued therapy even though there was a decrease in procalcitonin (not procalcitonin-guided group). 

The researchers recorded antibiotic therapy duration and unfavorable VAP outcomes in both groups. 

Overall, the algorithm was overruled in 81 patients (51.6%). These participants utilized antibiotic therapy significantly longer than those in the procalcitonin-guided group (9.5 vs. 8.0 days). This 1.5-day difference in therapy duration was present even though the participants’ baseline and VAP characteristics did not differ. 

Additionally, following the algorithm did not compromise the participants’ outcome in terms in intensive care unit mortality or VAP relapse rate, as the rate of unfavorable outcomes were comparable between the not procalcitonin-guided group (46.9%) and the procalcitonin-guided group (51.3%). 

—Colleen Murphy

Reference:

Beye F, Vigneron C, Dargen A, et al. Adhering to the procalcitonin algorithm allows antibiotic therapy to be shortened in patients with ventilator-associated pneumonia. J Crit Care. 2019;53:125-131. doi:10.1016/j.jcrc.2019.05.022.