Interventional Study Of Procalcitonin-guided Antibiotic Therapy In Long-term Comatose Patients With Tracheostomy And Positive Sputum Culture

Objective To evaluate the value of procalcitonin in the guidance of antibiotic therapy in long-term comatose patients with tracheotomy and positive sputum culture.Methods A total of 108 long-term comatose patients with tracheotomy and positive sputum culture from Huashan Hospital and Renhe branch. Fudan University were enrolled in the study from August 1st,2012 to December 31 st,2013. All patients were randomized into two groups. The interventional group were required to receive antibiotic therapy depending on PCT serum concentration tested within 2 hours and in the morning of day 2,3,5,7,10 after admission while the control group received standard antibiotic therapy. Antibiotics were recommended at a PCT threshold of 0.25ng·mL-1,Clinical variables such as gender, age, underlying disease, the daily highest temperature. Glasgow Coma Score. APACHE Ⅱ score. Clinical Pulmonary Infection Score and lab findings such as C-reaction protein(CRP). White Blood Counts(WBC). the percent of neutrophile granulocyte(N%) were collected. The primary endpoint was pneumonia recurrence at day 14 after antibiotic discontinuation. The second endpoints were 28-day mortality, the proportion of patients with antibiotic therapy, duration of antibiotic therapy and related cost.Results 55 cases were assigned to PCT-guided group and the remaining in the control group. Antibiotics were prescribed in 29.1% of patients in the PCT-guided group as compared to 60.4% of patients in the control group(P<0.01). The duration of antibiotic therapy was 12.19 days in the PCT group and 15.19 days in the control group (P=0.042). The overall average cost of the PCT group is. The overall average daily cost of the PCT group was 462.39 RMB and 514.78 RMB in the control group (P=0.041). No significant difference was observed in pathogens between the PCT group and the control group. The number of drug resistance was 4 patients at the time of discharge the same as on admission in the control group. Drug resistance was found in 2 patients on admission and was increased to 8 patients at discharge time in the PCT group (P=0.046).There were 4 patients were readmitted for pneumonia recurrence within 14 days after antibiotic discontimuation in the PCT-group and 5 patients in the control group.1 death occurred in the PCT group versus 2 death in the control group within 28 days.Conclusion Use of antibiotics could be reduced with PCT-directed algorithm in long-term comatose patients with tracheotomy and positive sputum culture. At Hospital cost and drug-resistant bacteria could thus also be curbed. There was no statistically significant difference of 14-day pneumonia recurrence and 28-day mortality between the PCT group and the control group.