Clinical Significance Of Serum PCT Detection Combined With Simplified CPIS Score In Guiding The Application Of Antibiotics In Patients With Severe Pneumonia In Primary Hospitals

Objective: To investigate the clinical value and significance of decreasing the step –by-step use of antibiotics in patients with severe pneumonia by dynamically monitoring serum procalcitonin(PCT)levels and combining with simplified clinical pulmonary infection score(CPIS).Methods:1.According to the diagnostic criteria of adult severe pneumonia published jointly by American infectious diseases association / American chest science association(IDSA / ATS)in 2007,60 cases of severe pneumonia were collected from January 2016 to October 2017 in shenyang 242 hospital.All of them were bacterial infections.The patients were divided into experimental group(30 cases)and control group(30 cases)by random number table method.There was no significant difference between the two groups in gender,age,lesion location,etiology and other aspects(p > 0.05),which was comparable.2.The control group was treated with antibiotics according to the routine examination and laboratory test of the patients.The experimental group dynamically monitored the level of serum procalcitonin on day 1,3,7,10,meanwhile,simplified clinical pulmonary infection score was carried out,according to the changes of serum procalcitonin level and clinical pulmonary infection score results,antibiotic therapy was used to reduce the steps.For the patients with score ? 5 points,according to the dynamic change of serum procalcitonin,the ladder-down treatment was adopted.The first choice was broad-spectrum antibacterial,enzyme-resistant cephalosporin and quinolone antibiotics.After 72 h of treatment,sensitive antibiotics were selected according to the results of bacteriology and drug sensitivity test.When the absolute value of PCT < 0.25 ng / ml,and CPIS score ? 4 points,stop antibiotics;In the experimental group,patients with CPIS score ? 4 were treated with step-down therapy according to the dynamic changes of PCT.3.Analysis and comparison of the two groups of patients with antibiotic application time and pharmacoeconomic differences;Analysis and comparison of the two groups of patients with antibiotic application time and pharmacoeconomics differences;The control time of complications was analyzed and compared between the two groups.The disease outcomes of the two groups were analyzed and compared.4.SPSS 19.0 was used to process the data,?~2 test was used to count the data,the mean standard deviation((?)±s)was used to count the data,t test was used to compare the groups,p < 0.05 as the difference was statistically significant.Results:1.There was a significant difference between the two groups(p < 0.05).The number of days of antibiotic application in the experimental group was significantly less than that in the control group.2.The control time of complications in the experimental group was significantly shorter than that in the control group.3.The total hospitalization cost of the experimental group was significantly lower than that of the control group,the difference was statistically significant(p < 0.05),but there was no significant difference between the two groups(p > 0.05).4.The incidence of mold infection in the experimental group was lower than that in the control group(p < 0.05).There was no significant difference in clinical cure rate between the two groups.Conclusion:Monitoring the serum procalcitonin level in patients with severe pneumonia,combined with clinical pulmonary infection score can guide the rational use of antibiotics in clinical work for patients with severe pneumonia,while effectively controlling the infection can reduce the time of antibiotic use,shorten the length of hospital stay,reduce the economic burden of patients,and can reduce the incidence of bacterial resistance and double infection.