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Procalcitonin for Predicting Recurrence in Culture-Negative Ventilator Associated Pneumonia
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A3281 - Procalcitonin for Predicting Recurrence in Culture-Negative Ventilator Associated Pneumonia
Author Block: Y. T. Hoang; Intensive care unit, University Medical Center, Ho Chi Minh City, Viet Nam.
Rationale: Early discontinuation of antibiotics is recommended in ventilator associated pneumonia (VAP) with negative sputum culture, with recurrence is an impending complication. Procalcitonin (PCT) can be used to diagnose infection in critically ill patients. This study aimed to determine the role of PCT in predicting recurrent pneumonia after withdrawing antibiotics. Methods: A prospective, observational study was conducted in a 30-bed mixed ICU of a teaching hospital. Enrolling criteria were (1) clinically diagnosed VAP with negative sputum culture, (2) empiric antibiotics were discontinued at attending physician’s discretion. Recurrent pneumonia was defined as fulfillment of clinical ATS criteria plus positive quantitative endotracheal aspirate culture at 48 hours after discontinuation of ATB. Results: 43 patients with negative culture were enrolled from 2014 to 2016 with Acute Physiology and Chronic Health Evaluation (APACHE) II score of 18.05 ± 4.86 and modified Clinical Pulmonary Infection Score (mCPIS) of 4.33 ± 1.85. Recurrent pneumonia occurred in 12 patients (27.9%) after antibiotics discontinuation. PCT on the day of VAP diagnosis (PCT0) in recurrent pneumonia group (6.81 ± 14.77) was not different from PCT0 in non-recurrent pneumonia group (3.24 ± 4.78) (p = 0.43). PCT on the day of antibiotic discontinuation (PCT1) in both recurrent and non-recurrent pneumonia groups were respectively 0.75 ±1.06 vs 0.45 ± 0.85 (p = 0.34). mCPIS score on the day of VAP diagnosis in recurrent pneumonia group (5.42 ± 2.19) was significantly higher than in non-recurrent pneumonia group (3.90 ± 1.54) (p = 0 .014). The area under the receiver operating characteristic curve for PCT0, PCT1 and mCPIS were 0.56, 0.57 and 0.715, respectively. Conclusions: There is a high rate of recurrent pneumonia after discontinuation of antibiotics in culture-negative VAP and PCT fails to predict this complication.
Author Block: Y. T. Hoang; Intensive care unit, University Medical Center, Ho Chi Minh City, Viet Nam.
Rationale: Early discontinuation of antibiotics is recommended in ventilator associated pneumonia (VAP) with negative sputum culture, with recurrence is an impending complication. Procalcitonin (PCT) can be used to diagnose infection in critically ill patients. This study aimed to determine the role of PCT in predicting recurrent pneumonia after withdrawing antibiotics. Methods: A prospective, observational study was conducted in a 30-bed mixed ICU of a teaching hospital. Enrolling criteria were (1) clinically diagnosed VAP with negative sputum culture, (2) empiric antibiotics were discontinued at attending physician’s discretion. Recurrent pneumonia was defined as fulfillment of clinical ATS criteria plus positive quantitative endotracheal aspirate culture at 48 hours after discontinuation of ATB. Results: 43 patients with negative culture were enrolled from 2014 to 2016 with Acute Physiology and Chronic Health Evaluation (APACHE) II score of 18.05 ± 4.86 and modified Clinical Pulmonary Infection Score (mCPIS) of 4.33 ± 1.85. Recurrent pneumonia occurred in 12 patients (27.9%) after antibiotics discontinuation. PCT on the day of VAP diagnosis (PCT0) in recurrent pneumonia group (6.81 ± 14.77) was not different from PCT0 in non-recurrent pneumonia group (3.24 ± 4.78) (p = 0.43). PCT on the day of antibiotic discontinuation (PCT1) in both recurrent and non-recurrent pneumonia groups were respectively 0.75 ±1.06 vs 0.45 ± 0.85 (p = 0.34). mCPIS score on the day of VAP diagnosis in recurrent pneumonia group (5.42 ± 2.19) was significantly higher than in non-recurrent pneumonia group (3.90 ± 1.54) (p = 0 .014). The area under the receiver operating characteristic curve for PCT0, PCT1 and mCPIS were 0.56, 0.57 and 0.715, respectively. Conclusions: There is a high rate of recurrent pneumonia after discontinuation of antibiotics in culture-negative VAP and PCT fails to predict this complication.
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