降钙素原指导抗生素策略对脓毒症患者抗菌药物使用的效果评价被引量：7

Clinical effect of procalcitonin-guided therapy for antibiotic use in patients with sepsis

下载PDF

导出

摘要目的评价降钙素原(PCT)指导抗生素策略在脓毒症患者中应用的有效性,为临床决策提供参考依据。方法计算机检索Pub Med、EMbase、the Cochrane Library、Web of Science、CBMdisc、CNKI和万方数据库,收集关于PCT指导抗生素治疗脓毒症患者有效性的临床随机对照试验(RCT),检索时间从建库至2015年3月。由2位研究者按纳入标准独立筛选文献、提取资料并评价质量后,采用Rev Man 5.3软件进行Meta分析。结果纳入10个RCT,共1 620例患者。Meta分析结果提示,与常规治疗组比较,PCT指导组能够缩短抗生素使用时间和总住院时间[MD_1=-1.41,(95%CI_1:-2.15,-0.68),P_1=0.000;MD_2=-2.98,(95%CI_2:-4.92,-1.05),P_2=0.002],而在院内病死率、28 d病死率和ICU住院时间方面比较,差异无统计学意义[RR1=0.98,(95%CI1:0.72,1.33),P_1=0.090;RR_2=1.03,(95%CI_2:0.85,1.24),P_2=0.770;MD_3=-0.01,(95%CI_3:-0.27,0.25),P_3=0.930]。结论 PCT指导抗生素策略能够缩短脓毒症患者的抗生素使用时间和总住院时间,而对院内病死率和28 d死亡率无明显影响。但尚需大样本、高质量的RCT验证。 Objective To explore the efficacy of procalcitonin（PCT） algorithms for antibiotic treatment decisions in adult patients with sepsis, so as to provide a reference for clinical decision. Methods Pub Med,EMbase, the Cochrane Library, Web of Science, CBMdisc, CNKI and Wanfang databases were systematically searched for randomized controlled trials（RCT） of PCT algorithms for antibiotic treatment in adult patients with sepsis. Study selection, data extraction and quality assessment were applied independently by two reviewers,and then Rev Man 5.2 software was used for conducting meta-analysis. Results A total of 10 RCTs including1,620 patients were included. The results of meta-analysis demonstrated that compared with the control group,the PCT-guided group significantly reduced the duration of antibiotic treatment and hospital stay [MD1=-1.41,95% CI1：（-2.15,-0.68）,P1= 0.000; MD2=-2.98, 95% CI2：（-4.92,-1.05）, P2= 0.002]; while there were no statistical differences in hospital mortality, 28-day mortality or duration of hospital stay in ICU between the two groups [RR1= 0.98, 95% CI1：（0.72, 1.33）, P1= 0.090; RR2= 1.03, 95% CI2：（0.85, 1.24）,P2= 0.770; MD3=-0.01, 95% CI3：（-0.27, 0.25）, P3= 0.930]. Conclusions PCT-guided therapy may reduce the duration of antibiotic treatment and hospital stay without affecting hospital mortality or 28-day mortality. However, high-quality and large-scale randomized controlled trials are still needed to confirm our study.

作者季一娟巢益群

机构地区江苏省常州市第四人民医院急诊科

出处《中国现代医学杂志》 CAS 北大核心 2016年第9期118-123,共6页 China Journal of Modern Medicine

关键词降钙素原脓毒症抗生素系统评价 procalcitonin sepsis antibiotic meta-analysis

分类号 R459.7 [医药卫生—急诊医学]

引文网络
相关文献

参考文献18

1MARTIN G S, MANNINO D M, EATON S, et al. The epidemiology of sepsis in the United States from 1979 through 2000[J]. N Engl J Med, 2003, 348(16): 1546-1554.
2WACKER C, PRKNO A, BRUNKHORST F M, et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis[J]. Lancet Infect Dis, 2013, 13(5): 426-435.
3SCHUETZ P, CHIAPPA V, BRIEL M, et al. Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms[J]. Arch Intern Med, 2011, 171(15): 1322-1331.
4ANNANE D, MAXIME V, FALLER J P, et al. Procalcitonin levels to guide antibiotic therapy in adults with non-microbiologically proven apparent severe sepsis: a randomised controlled trial[J]. BMJ Open, 2013, 3: e002186. DOI: 10.1136/bmjopen-2012-002186.
5BOUADMA L, LUYT C E, TUBACH F, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial[J]. Lancet, 2010, 375: 463-474.
6DELIBERATO R O, MARRA A R, SANCHES P R, et al. Clinical and economic impact of procalcitonin to shorten antimicrobial therapy inseptic patients with proven bacterial infection in an intensive care setting[J]. Diagn Microbiol Infect Dis, 2013, 76(3): 266-271.
7HOCHREITER M, KOEHLER T, SCHWEIGER A M, et al. Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial[J]. Crit Care, 2009, 13: 83.
8JENSEN J U, HEIN L, LUNDGREN B, et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial[J]. Crit Care Med, 2011, 39: 2048-2058.
9NOBRE V, HARBARTH S, GRAF L D, et al. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial[J]. Am J Respir Crit Care Med, 2008, 177: 498-505.
10SCHROEDER S, HOCHREITER M, KOEHLER T, et al. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study[J]. Langenbecks Arch Surg, 2009, 394: 221-226.

二级参考文献24

1葛庆岗,阴赪宏,文艳,吕旌乔,王谊冰.血清降钙素原与多器官功能障碍综合征严重程度相关性的临床研究[J].中国危重病急救医学,2005,17(12):729-731. 被引量：28
2姚咏明,盛志勇,林洪远,柴家科.2001年国际脓毒症定义会议关于脓毒症诊断的新标准[J].中国危重病急救医学,2006,18(11):645-645. 被引量：191
3奚晶晶,王红,杨钧.降钙素原在脓毒症患者中的动态变化及中药干预的影响[J].中国中西医结合急救杂志,2007,14(6):327-329. 被引量：40
4Angus DC,Linde-Zwirble WT,Lidicker J. Epidemiology of severe sepsis in the United States:analysis of incidence,outcome,and associated costs of care[J].Critical Care Medicine,2001.1303-1310.
5Coopersmith CM,Amiot DM 2nd,Stromberg PE. Antibiotics improve survival and alter the inflammatory profile in a murine model of sepsis from Pseudomonas aeruginosa pneumonia[J].Shock,2003.408-414.
6Jin M,Khan AI. Procalcitonin:uses in the clinical laboratory for the diagnosis of sepsis[J].Lab Medicine,2010.173-177.
7Gendrel D,Bohuon C. Procalcitonin,a marker of bacterial infection[J].Infection,1997.133-134.
8Patil VK,Morjaria JB,De Villers F. Associations between procalcitonin and markers of bacterial sepsis[J].Medicina,2012.383-387.
9Ruiz-Alvarez MJ,García-Valdecasas S,De Pablo R. Diagnostic efficacy and prognostic value of serum procalcitonin concentration in patients with suspected sepsis[J].Journal of Intensive Care Medicine,2009,(1):63-71.doi:10.1177/0885066608327095.
10Jekarl DW,Lee SY,Lee J. Procalcitonin as a diagnostic marker and IL-6 as a prognostic marker for sepsis[J].Diagnostic Microbiology and Infectious Disease,2013.342-347.