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Procalcitonin-based therapeutic strategy to reduce antibiotic use in patients after cardiac surgery: A randomized controlled trial

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Author(s): Maravić-Stojković Vera | Laušević-Vuk Ljiljana | Jović Miomir | Ranković Aleksandra | Borzanović Milorad | Marinković Jelena

Journal: Srpski Arhiv za Celokupno Lekarstvo
ISSN 0370-8179

Volume: 139;
Issue: 11-12;
Start page: 736;
Date: 2011;
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Keywords: procalcitonin | antibiotics | inflammatory mediators | cardiac surgery

ABSTRACT
Introduction. Procalcitonin (PCT) is a thyroid gland prohormone, and its serum concentration is elevated in systemic bacterial infections. The diagnostic cut-off value of PCT in patients early after cardiac surgery remains unclear. Objective. We investigated whether procalcitonin-guidance could reduce antibiotic usage safely. Methods. The prospective study included 205 patients who underwent open heart surgery. The patients were randomly assigned for procalcitonin-guided antibiotic treatment (PCT-group; n=102) or standard care (standard group; n=103). On the basis of serum procalcitonin concentrations, usage of antibiotics was encouraged (PCT≥0.5 ng/mL) or discouraged. Results. A relative risk of antibiotic exposure in the standard group compared with the PCT-group was 3.81 (95% CI=2.03-7.17; p0.05) days, respectively. Mortality rates were equal in both groups of patients (p=0.537). Conclusion. Procalcitonin-guided antibiotic treatment is safe and can significantly reduce the cost of postoperative care. Additionally, the antibiotic use during immediate postoperative course should be timely controlled and limited to documented bacterial infections.
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