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Procalcitonin to stop antibiotics after cardiovascular surgery in a pediatric intensive care unit—The PROSACAB study


Autoři: Sara Bobillo-Perez aff001;  Anna Sole-Ribalta aff001;  Monica Balaguer aff001;  Elisabeth Esteban aff001;  Monica Girona-Alarcon aff001;  Lluisa Hernandez-Platero aff001;  Susana Segura aff001;  Aida Felipe aff001;  Francisco Jose Cambra aff001;  Cristian Launes aff003;  Iolanda Jordan aff001
Působiště autorů: Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain aff001;  Disorders of Immunity and Respiration of the Pediatric Critical Patients Research Group, Institut Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain aff002;  Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain aff003;  Pediatric Infectious Diseases Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0220686

Souhrn

Introduction and objective

Children admitted to the pediatric intensive care unit after cardiovascular surgery usually require treatment with antibiotics due to suspicion of infection. The aim of this study was to assess the effectiveness of procalcitonin in decreasing the duration of antibiotic treatment in children after cardiovascular surgery.

Methods

Prospective, interventional study carried out in a pediatric intensive care unit. Included patients under 18 years old admitted after cardiopulmonary bypass. Two groups were compared, depending on the implementation of the PCT-guided protocol to stop or de-escalate the antibiotic treatment (Group 1, 2011–2013 and group 2, 2014–2018). This new protocol was based on the decrease of the PCT value by 20% or 50% with respect to the maximum value of PCT. Primary endpoints were mortality, stewardship indication, duration of antibiotic treatment, and antibiotic-free days.

Results

886 patients were recruited. There were 226 suspicions of infection (25.5%), and they were confirmed in 38 cases (16.8%). The global rate of infections was 4.3%. 102 patients received broad-spectrum antibiotic (4.7±1.7 days in group 1, 3.9±1 days in group 2 with p = 0.160). The rate of de-escalation was higher in group 2 (30/62, 48.4%) than in group 1 (24/92, 26.1%) with p = 0.004. A reduction of 1.1 days of antibiotic treatment (group 1, 7.7±2.2 and group 2, 6.7±2.2, with p = 0.005) and 2 more antibiotic free-days free in PICU in group 2 were observed (p = 0.001), without adverse outcomes.

Conclusions

Procalcitonin-guided protocol for stewardship after cardiac surgery seems to be safe and useful to decrease the antibiotic exposure. This protocol could help to reduce the duration of broad-spectrum antibiotics and the duration of antibiotics in total, without developing complications or adverse effects.

Klíčová slova:

Medicine and health sciences – Pharmacology – Drugs – Health care – Health care facilities – Hospitals – Intensive care units – Pulmonology – Respiratory infections – Pediatrics – Pediatric infections – Infectious diseases – Nosocomial infections – Bacterial diseases – Surgical and invasive medical procedures – Pediatric surgery – Biology and life sciences – Microbiology – Microbial control – Antimicrobials – Antibiotics


Zdroje

1. European Centre for Disease Prevention and Control. Annual Epidemiological Report 2016 –Healthcare-associated infections acquired in intensive care units. Stockholm [Internet]. 2016. https://ecdc.europa.eu/sites/portal/files/documents/AER-HCAI_ICU_3_0.pdf%0Ahttps://ecdc.europa.eu/en/publications-data/healthcare-associated-infections-acquired-intensive-care-units-annual

2. WHO. Antimicrobial resistance. Global report on surveillance. World Heal Organ. 2014;61: 383–394.

3. WHO. Report on the Burden of Endemic Health Care-Associated Infection Worldwide. WHO Library Cataloguing-in-Publication Data. 2011. http://whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf

4. Grisaru-Soen G, Paret G, Yahav D, Boyko V, Lerner-Geva L. Nosocomial infections in pediatric cardiovascular surgery patients: A 4-year survey. Pediatr Crit Care Med. 2009;10: 202–206. doi: 10.1097/PCC.0b013e31819a37c5 19188871

5. Guardia M, García IJ, Ayala MU. Infección nosocomial en postoperados de cirugía cardíaca. An Pediatr. 2008;69: 34–38.

6. O’Keefe S, Williams K, Legare J-F. Hospital-acquired infections after cardiac surgery and current physician practices: a retrospective cohort study. J Clin Med Res. 2017;9: 10–16. doi: 10.14740/jocmr2637w 27924169

7. Bobillo-Perez S, Rodríguez-Fanjul J, Jordan Garcia I. Is Procalcitonin Useful in Pediatric Critical Care Patients? Biomark Insights. 2018;13: 117727191879224. doi: 10.1177/1177271918792244 30093797

8. Sariego-Jamardo A, Rey C, Medina A, Mayordomo-Colunga J, Concha-Torre A, Prieto B, et al. C-reactive protein, procalcitonin and interleukin-6 kinetics in pediatric postoperative patients. J Crit Care. Elsevier Inc.; 2017;41: 119–123. doi: 10.1016/j.jcrc.2017.05.009 28514716

9. Garcia IJ, Gargallo MB, Torné EE, Lasaosa FJC, Viñas AT, Tolosa CV., et al. Procalcitonin: A useful biomarker to discriminate infection after cardiopulmonary bypass in children. Pediatr Crit Care Med. 2012;13: 441–445. doi: 10.1097/PCC.0b013e31823890de 22422165

10. Davidson, Tong Suhong, Hauck Amanda, Lawson D. Scott, da Cruz Eduardo K. Kinetics of procalcitonin and C-reactive protein and the relationship to postoperative infection in young infants undergoing cardiovascular surgery. Pediatr Res. 2013;74: 413–419. doi: 10.1038/pr.2013.124 23863853

11. Bobillo Pérez S, Rodríguez-Fanjul J, García IJ, Hernando JM, Sanz MI. Procalcitonin is a better biomarker than C-reactive protein in newborns undergoing cardiac surgery: The PROKINECA study. Biomark Insights. 2016;11: 123–129. doi: 10.4137/BMI.S40658 27840575

12. Bobillo S, Rodríguez-Fanjul J, Solé A, Moreno J, Balaguer M, Esteban E, et al. Kinetics of Procalcitonin in Pediatric Patients on Extracorporeal Membrane Oxygenation. Biomark Insights. 2018;13: 117727191775190. doi: 10.1177/1177271917751900 29343939

13. Carr JA. Procalcitonin-guided antibiotic therapy for septic patients in the surgical intensive care unit. J Intensive Care. Journal of Intensive Care; 2015;3: 1–8.

14. Stocker M, Fontana M, El Helou S, Wegscheider K, Berger TM. Use of procalcitonin-guided decision-making to shorten antibiotic therapy in suspected neonatal early-onset sepsis: Prospective randomized intervention trial. Neonatology. 2010;97: 165–174. doi: 10.1159/000241296 19776651

15. Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: A randomized trial. Am J Respir Crit Care Med. 2008;177: 498–505. doi: 10.1164/rccm.200708-1238OC 18096708

16. Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. Elsevier Ltd; 2010;375: 463–474. doi: 10.1016/S0140-6736(09)61879-1

17. Schuetz P, Muller B, ChristCrain M, Stolz D, Tamm M, Bouadma L, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2012; 1–73. www.cochranelibrary.com 22972110

18. Wirz Y, Meier MA, Bouadma L, Luyt CE, Wolff M, Chastre J, et al. Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials. Crit Care. Critical Care; 2018;22: 1–11.

19. Mermel L, Allon M, Bouza E, Craven D, Flynn P, O’Grady N, et al. Clinical practice guidlines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;49: 1–45.

20. American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171: 388–416. doi: 10.1164/rccm.200405-644ST 15699079

21. Keren R, Chan E. A meta-analysis of randomized, controlled trials comparing short- and long-course antibiotic therapy for urinary tract infections in children. Pediatrics. 2002;109: 1–6.

22. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36: 309–332. doi: 10.1016/j.ajic.2008.03.002 18538699

23. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39: 165–228. doi: 10.1007/s00134-012-2769-8 23361625

24. Lacour-Gayet F, Clarke D, Jacobs J, Gaynor W, Hamilton L, Jacobs M, et al. The Aristotle score for congenital heart surgery. Pediatr Card Surg Annu. 2004;7: 185–191. doi: 10.1053/j.pcsu.2004.02.011

25. Davidson J, Tong S, Hancock H, Hauck A, da Cruz E K J. Prospective validation of the vasoactive-inotropic score and correlation to short term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med. 2012;38: 1184–1190. doi: 10.1007/s00134-012-2544-x 22527067

26. Álvarez P, Fuentes C, García N, Modesto V. Evaluation of the duration of the antibiotic prophylaxis in paediatric postoperative heart surgery patients. Pediatr Cardiol. 2012;33: 735–738. doi: 10.1007/s00246-012-0202-2 22349725

27. de Jong E, van Oers JA, Beishuizen A, Vos P, Vermeijden WJ, Haas LE, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: A randomised, controlled, open-label trial. Lancet Infect Dis. Elsevier Ltd; 2016;16: 819–827. doi: 10.1016/S1473-3099(16)00053-0

28. Huang H-B, Peng J-M, Weng L, Wang C-Y, Jiang W, Du B. Procalcitonin-guided antibiotic therapy in intensive care unit patients: a systematic review and meta-analysis. Ann Intensive Care. Springer International Publishing; 2017;7: 114. doi: 10.1186/s13613-017-0338-6 29168046

29. Andriolo BNG, Andriolo RB, Salomão R, Atallah ÁN. Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock. Cochrane Database Syst Rev. 2017; CD010959. doi: 10.1002/14651858.CD010959.pub2 28099689

30. Schuetz P, Müller B, Stolz D, Tamm M, Bouadma L, Ce L, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections (Review). Cochrane Database Syst Rev. 2017; 1–128. www.cochranelibrary.com 29025194

31. Huang DT, Yealy DM, Filbin MR, Brown AM, Chang C-CH, Doi Y, et al. Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection. N Engl J Med. 2018;379: 236–249. doi: 10.1056/NEJMoa1802670 29781385

32. Slieker JC, Aellen S, Eggimann P, Guarnero V, Schäfer M, Demartines N. Procalcitonin-Guided Antibiotics after Surgery for Peritonitis: A Randomized Controlled Study. Gastroenterol Res Pract. 2017;2017: 1–6. doi: 10.1155/2017/3457614 28607552

33. Launes C, Esteban E, Balaguer M, Alsina M, Cambra FJ, Jordan I. Procalcitonin-guidance reduces antibiotic exposure in children with nosocomial infection (PRORANI). J Infect. 2016;72: 250–253. doi: 10.1016/j.jinf.2015.12.001 26706044

34. Jaworski R, Haponiuk I, Irga-Jaworska N, Steffens M, Chojnicki M, Paczkowski K, et al. Monitoring both procalcitonin and C-reactive protein in the early period after tetralogy of Fallot correction in children promotes rational antibiotic use. Adv Med Sci. Medical University of Bialystok; 2018;63: 112–118. doi: 10.1016/j.advms.2017.10.003 29111402

35. Stocker M, van Herk W, el Helou S, Dutta S, Fontana MS, Schuerman FABA, et al. Procalcitonin-guided decision making for duration of antibiotic therapy in neonates with suspected early-onset sepsis: a multicentre, randomised controlled trial (NeoPIns). Lancet. 2017;390: 871–881. doi: 10.1016/S0140-6736(17)31444-7 28711318

36. Edwards FH, Engelman RM, Houck P, Shahian DM, Bridges CR. The Society of Thoracic Surgeons practice guideline series: Antibiotic prophylaxis in cardiac surgery, part I: Duration. Ann Thorac Surg. 2006;81: 397–404. doi: 10.1016/j.athoracsur.2005.06.034 16368422

37. Gelijns AC, Moskowitz AJ, Acker MA, Argenziano M, Geller NL, Puskas JD, et al. Management Practices and Major Infections After Cardiac Surgery. J Am Coll Cardiol. 2014;64: 372–381. doi: 10.1016/j.jacc.2014.04.052 25060372


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