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Cited by 327Nosocomial Infections in ICUSepsis Diagnosis and TreatmentAntibiotic Use and Resistance

Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study

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Stolz, D., Smyrnios, N., Eggimann, P., Pargger, H., Thakkar, N., Siegemund, M., Marsch, S., Azzola, A. +3 more·2009·European Respiratory Journal
DOI 10.1183/09031936.00053209
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Abstract

In patients with ventilator-associated pneumonia (VAP), guidelines recommend antibiotic therapy adjustment according to microbiology results after 72 h. Circulating procalcitonin levels may provide evidence that facilitates the reduction of antibiotic therapy. In a multicentre, randomised, controlled trial, 101 patients with VAP were assigned to an antibiotic discontinuation strategy according to guidelines (control group) or to serum procalcitonin concentrations (procalcitonin group) with an antibiotic regimen selected by the treating physician. The primary end-point was antibiotic-free days alive assessed 28 days after VAP onset and analysed on an intent-to-treat basis. Procalcitonin determination significantly increased the number of antibiotic free-days alive 28 days after VAP onset (13 (2–21) days versus 9.5 (1.5–17) days). This translated into a reduction in the overall duration of antibiotic therapy of 27% in the procalcitonin group (p = 0.038). After adjustment for age, microbiology and centre effect, the rate of antibiotic discontinuation on day 28 remained higher in the procalcitonin group compared with patients treated according to guidelines (hazard rate 1.6, 95% CI 1.02–2.71). The number of mechanical ventilation-free days alive, intensive care unit-free days alive, length of hospital stay and mortality rate on day 28 for the two groups were similar. Serum procalcitonin reduces antibiotic therapy exposure in patients with ventilator associated pneumonia.

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  • Some studies in critically ill patients have reported benefits in terms of clinical cure when applying PK/PD principles to dosing.

    “Some studies in critically ill patients have reported benefits in terms of clinical cure (237,(250)(251)(252)(253).”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [250]

    The Antibiotic treatment and Randomisation sections describe procalcitonin-guided decisions about when to reduce or discontinue antibiotics, not dosing based on pharmacokinetic/pharmacodynamic (PK/PD) principles. The Discussion reports reduced antibiotic exposure, and the supplied discussion passage says shorter treatment was not associated with a worse outcome; neither establishes a benefit in clinical cure from PK/PD-guided dosing. Searched the indexed copy for PK/PD dosing and clinical cure; the returned passages have no page numbers. (LLM, conf=0.74)

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Research works printed but not linked: 42

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Authors
Stolz, D., Smyrnios, N., Eggimann, P., Pargger, H., Thakkar, N., Siegemund, M., Marsch, S., Azzola, A., Rakic, J., Mueller, B., & Tamm, M.
Affiliations
  • Harvard University (US)
  • Centre Hospitalier Universitaire Vaudois (CH)
  • University Hospital of Basel (CH)
  • Ospedale regionale di Lugano (CH)
Corresponding author
Stolz, D.
ORCID
Venue
European Respiratory Journal
Publisher
European Respiratory Society (ERS)
Published
2009-09-24
Volume
34
Issue
6
Pages
1364-1375
ISSN
  • 0903-1936 (ISSN-L)
  • 1399-3003
DOI
10.1183/09031936.00053209
OpenAlex
W2162272618
Cited by
327
References
44
Citations by year
2026: 6 · 2025: 11 · 2024: 12 · 2023: 17 · 2022: 14 · 2021: 21 · 2020: 22 · 2019: 20 · 2018: 22 · 2017: 25 · 2016: 15 · 2015: 18 · 2014: 18 · 2013: 26 · 2012: 35
FWCI
19.83
Type
journal article
Language
en
Open access
Locations
  • European Respiratory Journal (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Keywords
procalcitonin, ventilator-associated pneumonia, antibiotic stewardship, antibiotic discontinuation, antibiotic duration, biomarkers, mechanical ventilation, critically ill patients
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Calcitonin, Female, Humans, Male, Middle Aged, Protein Precursors, Time Factors, Calcitonin Gene-Related Peptide, Proportional Hazards Models, Treatment Outcome, Guidelines as Topic, Pneumonia, Ventilator-Associated

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