scholarly journals Duration of antibiotic therapy in critically ill patients: a randomized controlled trial of a clinical and C-reactive protein-based protocol versus an evidence-based best practice strategy without biomarkers

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Isabela Borges ◽  
◽  
Rafael Carneiro ◽  
Rafael Bergo ◽  
Larissa Martins ◽  
...  
2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Wan Fadzlina Wan Muhd Shukeri ◽  
Azrina Md. Ralib ◽  
Mohd Basri Mat-Nor

Introduction: Antibiotic therapy is of great importance in sepsis but prolonged duration can add to the emergence of antibiotic resistance. We aimed to examine whether point-of-care (POC) procalcitonin (PCT) guidance can safely reduce the duration of antibiotic use in infected critically ill patients. Materials and Methods: Eighty adult patients admitted to or acquired sepsis in the intensive care unit (ICU) were enrolled in this randomized controlled trial. Patients were allocated to either POC PCT-guided intervention arm (n=40) or the control arm, in which antibiotic therapy followed local guidelines (n=40). In the PCT-guided arm, antibiotic treatment was discontinued if clinical signs of infection improved and the PCT concentration decreased by >80% of its peak value, or when it reaches a value of <0·5 g/L. Results: The mean duration of antibiotic use for PCT arm was 6.4 (SD 2.3) days compared to 9 (SD 4.3) days in the control arm (p=0.004). In the first 30 days after being assigned to a group, the proportion of patients who received a repeated course of systemic antibiotics was 33% in the PCT arm vs 38.1% in the control arm (p=0.757). Mean length of stay in the ICU was 8.4 (SD 5.3) days in the PCT arm vs 10.4 (SD 12.3) days in the control arm (p=0.404). Mortality at 30 days was 22.5% in the PCT-arm vs 25% in the control arm (p<0.0001). Conclusion: POC PCT guidance stimulates reduction of duration of antibiotic use in ICU, accompanied by a significant decrease in mortality.


Nutrients ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 3518
Author(s):  
Chen-Yu Wang ◽  
Pin-Kuei Fu ◽  
Wen-Cheng Chao ◽  
Wei-Ning Wang ◽  
Chao-Hsiu Chen ◽  
...  

Although energy intake might be associated with clinical outcomes in critically ill patients, it remains unclear whether full or trophic feeding is suitable for critically ill patients with high or low nutrition risk. We conducted a prospective study to determine which feeding energy intakes were associated with clinical outcomes in critically ill patients with high or low nutrition risk. This was an investigator-initiated, single center, single blind, randomized controlled trial. Critically ill patients were allocated to either high or low nutrition risk based on their Nutrition Risk in the Critically Ill score, and then randomized to receive either the full or the trophic feeding. The feeding procedure was administered for six days. No significant differences were observed in hospital, 14-day and 28-day mortalities, the length of ventilator dependency, or ICU and hospital stay among the four groups. There were no associations between energy and protein intakes and hospital, 14-day and 28-day mortalities in any of the four groups. However, protein intake was positively associated with the length of hospital stay and ventilator dependency in patients with low nutrition risk receiving trophic feeding. Full or trophic feeding in critically ill patients showed no associations with clinical outcomes, regardless of nutrition risk.


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