Impacto clínico e econômico da procalcitonina na duração da antibioticoterapia de pacientes sépticos com infecção bacteriana microbiologicamente comprovada em unidade de terapia intensiva
Data
2015-02-06
Autores
Deliberato, Rodrigo Octavio 
Orientadores
Marra, Alexandre Rodrigues
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
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Resumo
Introdução: Recentemente biomarcadores, como a procalcitonina, vem sendo estudado na tentativa de ajudar os médicos a diminuir a duração do tempo da terapia antimicrobiana. Nosso objetivo foi o de avaliar se os níveis séricos da procalcitonina podem ser usados para diminuir o tempo da duração da terapia antimicrobiana em paciente sépticos de unidade de terapia intensiva com infecções bacterianas microbiologicamente comprovadas com segurança. Métodos: Este estudo foi realizado em uma UTI clínico cirúrgica de 41 leitos de um hospital terciário. De Março de 2008 a Fevereiro de 2010 nós avaliamos 265 pacientes com suspeita de sepse, sepse grave e choque séptico. Destes, 81 pacientes com infecções bacterianas microbiologicamente comprovadas foram randomizados em dois grupos: grupo procalcitonina, no qual a duração da antibioticoterapia era guiada por um algoritmo baseado nos níveis séricos de procalcitonina e no grupo controle, no qual não havia nenhum algoritmo guiando a duração da antibioticoterapia. No grupo intervenção os níveis séricos de procalcitonina era colhidos no primeiro e quinto dia de tratamento (sétimo dia, se infecção da corrente sanguínea) e de 48 em 48 horas após. O tratamento com antibióticos era interrompido quando: (1) O nível sérico da procalcitonina diminuia mais de 90% do valor inicial ou (2) se o valor absoluto fosse menor que 0,5 ng/mL. Resultados: A análise ?intention-to-treat? mostrou uma mediana de 10 dias de tratamento antimicrobiano no grupo procalcitonina (n=42) vs. 11 dias no grupo controle (n=39), p=0,44. Na análise ?perprotocol?, a mediana de dias do tratamento antimicrobiano foi de 09 dias no grupo procalcitonina (n=20) vs. 13 dias no grupo controle (n=31), p=0,008. A maior parte dos pacientes deste estudo tinha infecções da corrente sanguínea (58%). Conclusões: Este estudo demonstrou que a procalcitonina pode ser usada com segurança para limitar a duração da terapia antimicrobiana em pacientes sépticos de UTI com infecções bacterianas microbiologicamente comprovadas sem piorar o desfecho clínico destes pacientes.
Introduction: Recently, biomarkers like procalcitonin (PCT) have been studied in order to help physicians to decrease the duration of antibiotic therapy. Our objective was to assess whether the decrease in PCT levels could be used to reduce the antibiotic therapy in critically ill patients with a proven infection without risking a worse outcome. Methods: This study was conducted in a 41-bed medical-surgical ICU in a tertiary care hospital. From March 2008 to February 2010 we assessed 265 patients with suspected sepsis, severe sepsis or septic shock in our ICU. Of those, we randomized 81 patients with a proven bacterial infection into two groups: an intervention group, in which the duration of the antibiotic therapy was guided by a PCT protocol and a control group, in which there was no PCT guidance. In the intervention group, the PCT was measured in the first and fifth day of treatment (seventh only for bloodstream infection). Antibiotic treatment was stopped when: (1) PCT decreased 90% or more from the initial level or (2) an absolute value below 0.5ng/mL was reached. Results: The intention-to-treat analysis found that the median antibiotic duration was 10 days in the PCT group (n=42) vs. 11 days in non- PCT group (n=39), p=0.44. In the per protocol analysis, the median antibiotic duration was 09 days in the PCT group (n =20) vs. 13 days in the non-PCT group (n =31), p=0.008. The majority of patients had bloodstream infections (58%). Conclusions: This study demonstrates that PCT can be a useful tool for limiting antimicrobial therapy in ICU patients with documented bacterial infection, without untoward consequences to the clinical outcome of critically ill patients.
Introduction: Recently, biomarkers like procalcitonin (PCT) have been studied in order to help physicians to decrease the duration of antibiotic therapy. Our objective was to assess whether the decrease in PCT levels could be used to reduce the antibiotic therapy in critically ill patients with a proven infection without risking a worse outcome. Methods: This study was conducted in a 41-bed medical-surgical ICU in a tertiary care hospital. From March 2008 to February 2010 we assessed 265 patients with suspected sepsis, severe sepsis or septic shock in our ICU. Of those, we randomized 81 patients with a proven bacterial infection into two groups: an intervention group, in which the duration of the antibiotic therapy was guided by a PCT protocol and a control group, in which there was no PCT guidance. In the intervention group, the PCT was measured in the first and fifth day of treatment (seventh only for bloodstream infection). Antibiotic treatment was stopped when: (1) PCT decreased 90% or more from the initial level or (2) an absolute value below 0.5ng/mL was reached. Results: The intention-to-treat analysis found that the median antibiotic duration was 10 days in the PCT group (n=42) vs. 11 days in non- PCT group (n=39), p=0.44. In the per protocol analysis, the median antibiotic duration was 09 days in the PCT group (n =20) vs. 13 days in the non-PCT group (n =31), p=0.008. The majority of patients had bloodstream infections (58%). Conclusions: This study demonstrates that PCT can be a useful tool for limiting antimicrobial therapy in ICU patients with documented bacterial infection, without untoward consequences to the clinical outcome of critically ill patients.
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Citação
DELIBERATO, Rodrigo Octavio. Impacto clínico e econômico da procalcitonina na duração da antibioticoterapia de pacientes sépticos com infecção bacteriana microbiologicamente comprovada em unidade de terapia intensiva. 2015. 93 f. Tese (Doutorado em Infectologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.