Abstract
BackgroundThe rational use of antibiotics is one of the main strategies to limit the development of bacterial resistance. We therefore sought to evaluate the effectiveness of a C-reactive protein-based protocol in reducing antibiotic treatment time in critically ill patients.MethodsA randomized, open-label, controlled clinical trial conducted in two intensive care units of a university hospital in Brazil. Critically ill infected adult patients were randomly allocated to (i) intervention to receive antibiotics guided by daily monitoring of CRP levels and (ii) control to receive antibiotics according to the best practices for rational use of antibiotics.ResultsOne hundred thirty patients were included in the CRP (n = 64) and control (n = 66) groups. In the intention-to-treat analysis, the median duration of antibiotic therapy for the index infectious episode was 7.0 (5.0–8.8) days in the CRP and 7.0 (7.0–11.3) days in the control (p = 0.011) groups. A significant difference in the treatment time between the two groups was identified in the curve of cumulative suspension of antibiotics, with less exposure in the CRP group only for the index infection episode (p = 0.007). In the per protocol analysis, involving 59 patients in each group, the median duration of antibiotic treatment was 6.0 (5.0–8.0) days for the CRP and 7.0 (7.0–10.0) days for the control (p = 0.011) groups. There was no between-group difference regarding the total days of antibiotic exposure and antibiotic-free days.ConclusionsDaily monitoring of CRP levels may allow early interruption of antibiotic therapy in a higher proportion of patients, without an effect on total antibiotic consumption. The clinical and microbiological relevance of this finding remains to be demonstrated.Trial registryClinicalTrials.gov Identifier: NCT02987790. Registered 09 December 2016.
Highlights
The rational use of antibiotics is one of the main strategies to limit the development of bacterial resistance
Outcome results: intention-to-treat analysis The intention to treat (ITT) analysis revealed that the median duration of antibiotic therapy in the index episode of infection was similar in both groups, with first and third quartiles showing higher values in the control group: 7 (5–8.8) days in the C-reactive protein (CRP) group versus 7 (7–11.3) days in the control group (p = 0.011) (Table 2; Additional file 6)
Similar results were observed in post hoc analysis restricted to patients with Simplified Acute Physiology Score 3 (SAPS 3) less than or equal to 59 (n = 66) at admission, patients with community-acquired infections (n = 56), patients with lower-respiratory tract infections (n = 58), and those who had adequate initial empirical antimicrobial therapy (n = 117) (Additional file 8). In this randomized clinical trial, we investigated the usefulness of a CRP-based protocol to reduce the duration of antibiotic therapy in critically ill patients undergoing an evidence-based judicious use of antibiotics strategy
Summary
The rational use of antibiotics is one of the main strategies to limit the development of bacterial resistance. We sought to evaluate the effectiveness of a C-reactive protein-based protocol in reducing antibiotic treatment time in critically ill patients. One useful marker is procalcitonin (PCT), whose benefit in reducing antibiotic treatment time was demonstrated in several studies [11,12,13,14,15,16], including a potential reduction in the mortality of critically ill patients [14,15,16]. Few studies testing a CRP-guided strategy have been conducted in adult critical ill patients. A recent single-center clinical trial involving patients with sepsis suggested that CRP may be a useful marker to guide antibiotic treatment time, when compared to a PCT strategy [19]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
