降钙素原指导下减少腹部外科感染抗生素使用的临床研究

Use of procalcitonin to reduce patients' exposure to antibiotics in abdominal surgery:a retrospective trail

目的研究腹部外科感染病例中根据血清降钙素原(procalcitonin,PCT)的水平和变化情况来指导抗生素的使用,探讨PCT能否减少抗生素的使用,同时不增加严重的不良反应。方法回顾性分析腹部外科急性胰腺炎、急性化脓性胆管炎和急性弥漫性继发性腹膜炎病例的抗生素使用情况及治疗结果。病人分为两组,PCT组(76例)和传统标准治疗组(对照组,119例)。在PCT组按照预定的PCT浓度截断值开始和停止抗生素的使用,对照组按传统标准使用抗生素。结果 PCT组较对照组抗生素使用天数减少2.6 d。感染并发症和病死率两组差异无统计学意义。结论 PCT指导的抗生素治疗方案较传统标准方案可降低抗生素的用量,并且不增加不良的医疗结果。

Objective To examine whether a procalcitonin （PCT） algorithm can reduce antibiot- ics exposure without increasin~ the risk for serious adverse outcomes in abdominal surgery. Methods A retrospective control trail was performed on abdominal surgery patients with acute pancreatitis or a- cute suppurative cholangitis or acute secondary peritonitis. The patients were divided into two groups： administration of antibiotics based on a PCT algorithm with predefined cutoff ranges for initiating or stopping antibiotics （PCT group, n = 76） or according tostandard guidelines （control group, n = 119）. Results The rate of mortality and bacterial infection complication was similar in PCT and con- trol groups. The mean duration of antibiotics exposure in the PCT group was reduced by 2. 6 days. Conclusions In patients undergoign abdominal surgery, a strategy of PCT guidance compared with standard guideline resulted in similar rates of adverse outcome, as well as lower rates of antibiotic ex- posure.