Antibiotikatherapie bei operativen Intensivpatienten

Abstract

The development of resistance by infective bacterial species is an incentive to reconsider the indications and administration of available antibiotics. Correct recognition of the indications and duration of therapy are particularly important for the use of highly potent substances in the intensive care situation. There has as yet been no clinical chemical parameter which is capable of specifically distinguishing a bacterial infection from a viral or non-infectious inflammatory reaction, but it now appears that procalcitonin (PCT) offers this possibility. The present study was intended to clarify whether PCT can be used to guide antibiotic therapy in surgical intensive care patients. A total of 110 patients in a surgical intensive care ward receiving antibiotic therapy after confirmed infection or a high grade suspicion of infection were enrolled in this study. In 57 of these patients a new decision was reached each day as to whether the antibiotic therapy should be continued after daily PCT determination and clinical assessment. The control group consisted of 53 patients with a standardized duration of antibiotic therapy over 8 days. Demographic and clinical data were comparable in both groups. However, in the PCT group the duration of antibiotic therapy was significantly shorter compared to controls (5.9+/-1.7 vs. 7.9+/-0.5 days, p<0.001) without unfavorable effects on clinical outcome.

Update on Procalcitonin Measurements

“…This approach was mainly evaluated in patients with respiratory tract infections; however, it can also be used in critically ill patients with sepsis or severe sepsis of various origins [3, 4, 5, 6, 7]. In addition, in outpatients with respiratory tract infection and exacerbation of chronic obstructive pulmonary disease (COPD), antibiotic prescription rates were significantly reduced by the use of PCT [8, 9].…”

“…Specific indications like treatment of endocarditis or severe bone infection are excluded from this rule. Various studies indicate that a maximum duration of treatment of approximately seven days is enough to treat even a severe focus of bacterial infection or sepsis [3, 5, 6, 51, 52]. …”

Wie verlässlich ist die Bestimmung von Procalcitonin als Entzündungsmarker auf Intensivstation?/How reliable is procalcitonin as an inflammatory marker?

“…In dieser Studie konnte eine Reduktion der Antiobiosedauer um ca. 2 Tage erreicht werden ohne den klinischen Erfolg zu verschlechtern [38] . Die Bedeutung der PCT-Verlaufsmessungen wurde auch bei Intensivpatienten mit Sepsis und bestehender empirischen antibiotischen Therapie untersucht [39] .…”

Procalcitonin: a valuable markerfor assessment of the success of antimicrobial therapy for severe sepsis An analysis using routine clinical data

“…Hochreiter and Schröder showed that, in the case of adequate antibiotic therapy, PCT levels decrease significantly after 4 days [9]. In addition, Charles et al demonstrated that a lack of PCT reduction on day 3, compared with day 2 of antibiotic therapy, is a resilient indicator of inadequate treatment (OR = 10.29) [10].…”