Procalcitonin-Guided Antibiotics after Surgery for Peritonitis: A Randomized Controlled Study

Area of Science:

• Clinical Medicine
• Infectious Diseases
• Surgical Critical Care

Background:

• Serum procalcitonin (PCT) is established for guiding antibiotic therapy in respiratory infections.
• Its utility in tailoring postoperative antibiotic duration for peritonitis remains under investigation.

Purpose of the Study:

• To evaluate the efficacy of serum procalcitonin (PCT) levels in guiding postoperative antibiotic therapy duration for peritonitis patients.

Main Methods:

• A randomized controlled trial involving 162 peritonitis patients stratified by cause (gastrointestinal perforation, perforated appendicitis, postoperative complication).
• The study group received antibiotics guided by serum PCT levels, while the control group followed institutional guidelines for a fixed duration.
• The primary outcome measured was the duration of antibiotic administration.

Main Results:

• No significant difference in overall antibiotic duration was observed between the PCT-guided group and the control group.
• In the subgroup with gastrointestinal perforation, the PCT group received antibiotics for a median of 7 days versus 10 days in the control group (p=0.065).
• No significant differences were found in infectious complications, mortality, or hospital length of stay.

Conclusions:

• Serum procalcitonin (PCT) guidance did not significantly alter overall antibiotic duration for peritonitis.
• A potential benefit in reducing antibiotic duration was suggested in gastrointestinal perforation cases, though not statistically significant due to study power.
• Further research focusing solely on gastrointestinal perforation is recommended to confirm PCT's role.