Procalcitonin for reduced antibiotic exposure in Ventilator Associated Pneumonia - a randomized study

In patients with ventilator-associated pneumonia, guidelines recommend antibiotic therapy adjustment according to microbiology results after 72 hours. Circulating procalcitonin levels may provide evidence that facilitates reduction of antibiotic therapy.In a multicenter, randomized, controlled trial, 101 patients with VAP were assigned to an antibiotic discontinuation strategy according to guidelines (control group) or to serum procalcitonin concentrations (procalcitonin group) with an antibiotic regimen selected by the treating physician. The primary endpoint was antibiotic-free days alive assessed 28 days after VAP onset and analysed on an intent-to-treat basis.Procalcitonin determination significantly increased the number of antibiotic free-days alive 28 days after VAP onset (13 days [2-21] versus 9.5 days [1.5-17]). This translated into a reduction in the overall duration of antibiotic therapy of 27% in the procalcitonin group (p=0.038). After adjustment for age, microbiology, and center-effect, the rate of antibiotic discontinuation on day 28 remained higher in the procalcitonin group compared to patients treated according to guidelines (Hazard rate 1.6; 95 percent CI, 1.02-2.71). The number of mechanical ventilation-free days alive, ICU-free days alive, length of hospital stay and mortality rate on day 28 for the two groups were similar.Serum procalcitonin reduces antibiotic therapy exposure in patients with ventilator associated pneumonia.