ISSN: 1859 - 2872
Study on the role of some risk factors with recurrence in ventilator-associated pneumonia following discontinuation of procalcitonin-directed antibiotics
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Summary
Objective: To evaluate the role of some risk factors with recurrence in ventilator-associated pneumonia (VAP) following discontinuation of procalcitonin (PCT)-directed antibiotics at Intensive Care Units, 108 Military Central Hospital. Subject and method: 40 patients with VAP treated at Intensive Care Units, 108 Military Central Hospital from August 2019 to April 2020, these patients were discontinued after meeting the criteria of IDSA and ATS (2016) and were divided into two groups: Group with relapse of pneumonia within 7 days after stopping the antibiotic and group without relapse of pneumonia. Risk factors (CPIS score and characteristics of tracheal secretions) of possible recurrence of infection were evaluated using logistic regression analysis. Result: Of the eligible 40 patients with VAP, 14 patients suffered infection recurrence. CPIS score and characteristics of tracheal secretions were the independent risk factors (p=0.045 and p=0.041, respectively), accounting for infection recurrence. Simplified CPIS score ≥ 5 served a certain predictive value for infection recurrence in VAP considered antibiotic discontinuation (The area under the receiver operating characteristic curve 0.738, specificity 89.6%, sensitivity 53.3%, positive predictive value 75.7% and negative predictive value 72.6%). At the time of antibiotic discontinuation, differences between the two groups were not statistically significant in the proportion of patients with a tracheotomy and in the culture results of endotracheal aspirates (including semi-quantitative results and whether pathogens were multidrug-resistant [MDR] strains). Conclusion: CPIS score and characteristics of tracheal secretions can be used to predict infection recurrence following PCT-guided antibiotic discontinuation in VAP.
Keywords: Ventilator-associated pneumonia, procalcitonin, antibiotic therapy, antibiotic discontinuation, infection recurrence.
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References
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