怀疑败血症住院患者的生物标志物引导抗生素持续时间:ADAPT-败血症随机临床试验
Paul Dark1, Anower Hossain2, Daniel F McAuley3,4
1Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Critical Care Unit, Northern Care Alliance NHS Foundation Trust, Salford Care Organization, Greater Manchester, United Kingdom.
JAMA
|December 9, 2024
概括
与标准治疗相比,在危急性败血症患者中,用PCT监测可以安全地减少抗生素的持续时间. 对C反应蛋白 (CRP) 的监测没有显著改变抗生素持续时间或死亡结果.
科学领域:
- 危急护理医学
- 传染性疾病
- 临床试验
背景情况:
- 在危急病的成年人中治疗败血症通常需要长时间的抗生素治疗.
- 用于指导抗生素持续时间的生物标志物,如前素 (PCT) 和C反应蛋白 (CRP),但它们的有效性和安全性需要进一步的证据.
研究的目的:
- 评估C-反应蛋白 (CRP) 或PCT指导方案是否可以安全地减少疑似败血症的重症患者的抗生素治疗时间.
主要方法:
- 一个多中心随机临床试验,涉及英国重症监护室的2760名成年人.
- 患者被分配为每日PCT指导,每日CRP指导或标准护理方案.
- 主要结局包括总抗生素持续时间和28天全因死亡率.
主要成果:
- 与标准治疗相比,PCT指导的方案显著减少了抗生素的持续时间 (平均差异为0. 88天;P=0. 01) 并且对28天的全因死亡率没有劣势.
- 在CRP指导方案和标准治疗之间没有显著的抗生素持续时间差异 (P=.79).
- 与标准治疗相比,CRP指导方案的全因死亡率是不确定的.
结论:
- 在疑似败血症的重症患者中,PCT监测提供了一种安全有效的策略来缩短抗生素治疗时间.
- 在这项试验中,对C反应蛋白 (CRP) 的监测没有显示出降低抗生素持续时间或对死亡率产生明确影响的类似益处.
- 这些发现支持PCT作为生物标志物的使用,以优化重症监护机构的抗生素管理.
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