Discussion Of Serum Procalcitonin Level On The Value Of Antibiotic Treatment In Patients With Acute Exacerbation Of Chronic Obstructive Pulmonary Disease

Objective To evaluate the effect of serum procalcitonin level on guiding the optimized utilization of antibiotics in patients with acute exacerbation of chronic obstructive pulmonary disease.study the relations of the level of serum PCT in the lower respiratory tract bacterial infection's patient and the course of antibacterial treatment.Judge the short-term antibiotic therapy specifically can achieve the desired therapeutic effect,to evaluate the serum PCT level can become a laboratory indicator to guide the reasonable use of antibiotics in respiratory bacterial infectionsMethods 56 in-patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) which the serum PCT were＞0.25ug / L were randomized into PCT group(n = 26) and conventional treatment group(n = 30) in the department of geriatric respiratory medicine and the characteristic clinic Center of Respiratory disease from Sep 2006 to Aug 2007.In PCT group,the serum PCT was detected on 1,5,7 and 10 day.The PCT examination uses the semi-quantitative immunity chromatograph examination law, this determination uses the German production of PCT-Q test card from B.R.A.H.M.S company.Patients received antibiotics or not according to the level of serum PCT.PCT guide treatment strategies:PCT＜0.1 ug / L was that the absence of bacterial infection, avoid use of antibiotics;0.1 ug / L = PCT＜0.25 ug / L are considered bacterial infection impossible,does not encourage use of antibiotics;0.25 ug / L = PCT＜0.5 ug / L bacterial infection may be considered,the proposed use of antibiotics;PCT = 0.5 ug / L are considered that the bacterial infection existence,suggests the application of antibiotic intensely.In conventional treatment group,it was determinded by clinical symptom. Simultaneously,the sputum bacteriology and other laboratory index such as white blood cell count(WBC),C-reactive protein(CRP) were investigated in all groups.Duration of antibiotics use,hospitalization stay,clinical efficiency,functional status score,the incidence of Secondary infection,the number of aggravated cases and deaths were observed.Results Duration of antibiotics use in PCT group and conventional treatment group were 7-10d and 2w or more respectively,which was significant difference between two groups(p＜0.01);In two groups,hospitalization(p＜0.01),and the incidence of secondary infection(p＜0.05) were significant difference;The clinical efficiency, functional status score,mortality and aggravated cases in two groups was no significant difference(p＞0.05);between two groups;furthermore,clinical and experiment index were no significant difference(p＞0.05) in two groups after treatment.The PCT group and conventional treatment group have similar clinical efficiency(respectively is 80.77%and 76.67%,p＞0.05),and functional status score did not influenced by the reduction of antibiotic use cycle,some inflammatory indicators like WBC,CRP and so on in two groups does not have the significance difference after the treatment.but the hospitalization in PCT Group compared with in the conventional treatment groups was significantly shorter(13.31±7.71 days to 20.03±10.60 days,p＜0.01);The conventional treatment group has the double Secondary infection case number than in the PCT group(respectively 9 cases and 2 cases,p＜0.05).As a whole,in two groups total of seven cases aggravated,progress with the severe pneumonia(the PCT group has 3 cases, the conventional treatment group have 4 cases);Altogether 5 cases deaths,the cause of death was respiratory failure and/or merges other substantive internal or- gans disease (the PCT group has 2 cases,the conventional treatment group have 3 cases).In PCT groups,the number of patients which the serum PCT level was＞0.25 ug/L decreased gradually with antibioltics treated.The serum PCT level in most patients was decreased to 0.25ug/L after antibioltic treated in one week.There is no correlation between positive rate of bacteria by sputum culture and the increasing of PCT (p＞0.05).According to Anthonisen standard grouping,the serum PCT levels were no significant difference amongⅠ,ⅡandⅢAECOPD patients.Conclusion Serum procalcitonin level could guide the application of antibiotic on AECOPD patients,deplete the abusage of antibiotic and cut down the incidence of secondary infection.As a inflammation marker,PCT may serve as guidance for optimization use of antibiotics on AECOPD patients at some extent,especially for personalized medicine and drug resistance of bacteria.