[JAMA临床证据精要]:PCT监测指导急性上呼吸道与下呼吸道感染的抗生素治疗 | 中国病理生理学会危重病医学专业委员会
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[JAMA临床证据精要]:PCT监测指导急性上呼吸道与下呼吸道感染的抗生素治疗
2018年03月18日 研究点评, 进展交流 暂无评论

JAMA Clinical Evidence Synopsis

March 6, 2018

Procalcitonin Testing to Guide Antibiotic Therapy in Acute Upper and Lower Respiratory Tract Infections

Philipp Schuetz, Yannick Wirz, Beat Mueller

JAMA. 2018;319(9):925-926. doi:10.1001/jama.2018.0852

Abstract

Clinical Question 临床问题

Is the use of procalcitonin for guiding antibiotic decisions in patients with acute upper and lower respiratory tract infections associated with improved clinical outcomes compared with usual care?

与常规治疗相比,根据PCT指导急性上呼吸道和下呼吸道感染患者的抗生素治疗决策是否改善临床预后?

Bottom Line 概要

Among patients with varying types and severity of acute respiratory infection, using procalcitonin to guide decisions about antibiotics is associated with lower rates of antibiotic exposure, antibiotic-related adverse effects, and mortality.

对于各种不同种类及严重程度的急性呼吸道感染患者,根据PCT指导抗生素治疗决策减少抗生素暴露,减少抗生素相关副作用,并降低病死率

Evidence Profile 证据总结

No. of studies: 26 randomized clinical trials

研究数目:26项随机临床试验

Study years: published: 2004-2016; conducted, 2002-2015

研究年限:发表年限:2004-2016;完成年限:2002-2015

Last search date: February 10, 2017

最后检索日期:2017年2月10日

No. of patients: 6708 (men: 3808 [57%]; women: 2900 [43%]) with acute infections of the upper or lower respiratory tract, which included community-acquired pneumonia (n = 2910), exacerbation of chronic obstructive pulmonary disease due to infections (n = 1252), bronchitis (n = 544), ventilator-associated pneumonia (n = 380), hospital-acquired pneumonia (n = 505), upper respiratory infection (n = 552)

患者数:6708名(男性:3808名 [57%];女性:2900名 [43%])急性上呼吸道或下呼吸道感染患者,包括社区获得性肺炎(n = 2910),感染导致COPD加重(n = 1252),气管炎(n = 544),呼吸机相关肺炎(n = 380),医院获得性肺炎(n = 505)及上呼吸道感染(n = 552)

Race/ethnicity: Not reported

种族:未报告

Age: mean, 61 years (range, 19-92 years)

年龄:平均61岁(范围19-92岁)

Settings: Primary care, emergency department, medical ward, medical and surgical intensive care unit

场景:全科医疗,急诊科,内科病房,内科与外科ICU

Countries: Australia, Belgium, Brazil, China, Denmark, France, Germany, Italy, the Netherlands, Serbia, Switzerland, United States

国家:澳大利亚,比利时,巴西,中国,丹麦,法国,德国,意大利,荷兰,叙利亚,瑞士,美国

Comparison: Procalcitonin-guided antibiotic management vs routine clinical care

比较:PCT指导抗生素治疗与常规临床治疗

Primary outcome: 30-day mortality

主要预后终点:30天病死率

Secondary outcomes: Antibiotic use, adverse effects from antibiotics, length of stay

次要预后终点:抗生素使用,抗生素副作用,住院日

Summary of Findings 结果总结

Procalcitonin testing was associated with a shorter duration of antibiotic exposure (from a median of 7 days [interquartile range {IQR}, 3-11 days] to 5 days [IQR, 0-8 days]), mean shorter duration of infection (2.4 days [95% CI, 2.15-2.71 days]), and a 25% reduction in antibiotic-related adverse effects (247/1513 patients with procalcitonin testing [16.3%] vs 336/1521 controls [22.1%]; Table).

PCT监测伴随抗生素暴露时间缩短(中位数从7天 [四分位区间 {IQR}, 3-11天] 缩短到 5 天 [IQR, 0-8 天]),感染平均持续时间缩短 (2.4 天 [95% CI, 2.15-2.71 天]),抗生素相关副作用减少 25%(PCT监测组247/1513 [16.3%] vs 对照组336/1521  [22.1%]; Table).

Procalcitonin testing was associated with lower 30-day mortality (286 deaths/3336 patients with procalcitonin testing [8.6%] vs 336/3372 controls [10.0%]; adjusted odds ratio, 0.83 [95% CI, 0.70-0.99], P = .04). This favorable association was similar for distinct types of respiratory infections (ie, community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease, bronchitis, upper respiratory infections) and across subgroups by clinical setting (emergency department, medical ward, intensive care). However, there were too few deaths in primary care patients to assess the association of procalcitonin testing with mortality in primary care.

PCT监测伴随30天病死率降低(PCT监测组286例死亡/3336例患者 [8.6%] vs 对照组 336/3372 [10.0%];校正后比数比 0.83 [95% CI, 0.70-0.99], P = .04)。而且,PCT监测降低病死率的作用在不同种类呼吸道感染(即社区获得性肺炎,COPD加重,气管炎,上呼吸道感染)及不同临床场景亚组(急诊科,内科病房,ICU)均一致。然而,全科医疗患者死亡病例过少,无法评价PCT监测与病死率的相关性。

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