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

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.