Use of Procalcitonin to Guide Discontinuation of Antimicrobial Therapy in Patients with Persistent Intra-Abdominal Collections: A Case Series

Gabriel Motoa,Andrés F Henao-Martínez,Amy Pate,Daniel B Chastain,Leila Hojat,Carlos Franco-Paredes

doi:10.1155/2020/6342180

Abstract

Objective Limited evidence exists for the use of procalcitonin (PCT) to guide the duration of antimicrobial therapy in patients with intra-abdominal abscesses (IAA). In this case series, we describe clinical presentations and outcomes using PCT to guide cessation of antimicrobial therapy in patients with persistent IAA who exhibited clinical improvement. Methods A retrospective analysis of patients with IAA who had PCT levels available to review was performed in a tertiary academic teaching institution in the United States between 2017 and 2018. Demographics, clinical characteristics, and outcomes were obtained from the medical records. Patients were followed up for a minimum of 180 days after completion of antimicrobial therapy to determine if evidence of recurrence or mortality was present. Results We identified four patients with IAA. They underwent early drainage of the source of infection and received empiric antimicrobial therapy according to individual risk factors and clinical scenarios. Antimicrobials were discontinued after clinical and radiographic improvement and evidence of normal PCT levels, regardless of the persistence of fluid collections. No evidence of recurrence or mortality was observed during the follow-up period. Conclusions We found PCT to be a useful aid in the medical decision-making process to safely discontinue antimicrobial therapy in a series of patients with persistent intra-abdominal collections despite early drainage and appropriate course of antimicrobial therapy.

Highlights

Intra-abdominal infections are associated with high rates of complications and mortality [1, 2]. e general approach to patients with intra-abdominal infections includes opportune and adequate empirical antimicrobial therapy based on individual risk factors for resistant microorganisms in addition to identification and control of the infection source [3,4,5,6].One of the most controversial topics among clinicians managing patients with intra-abdominal abscesses (IAA)is the appropriate duration of antimicrobial treatment once the source of infection has been controlled
We identified four patients with IAA. ey underwent early drainage of the source of infection and received empiric antimicrobial therapy according to individual risk factors and clinical scenarios
We describe the usage of PCT as a marker to guide cessation of antimicrobial therapy in patients with IAA who exhibited clinical improvement despite the presence of persistent fluid collections

Summary

Objective

Limited evidence exists for the use of procalcitonin (PCT) to guide the duration of antimicrobial therapy in patients with intra-abdominal abscesses (IAA). In this case series, we describe clinical presentations and outcomes using PCT to guide cessation of antimicrobial therapy in patients with persistent IAA who exhibited clinical improvement. Antimicrobials were discontinued after clinical and radiographic improvement and evidence of normal PCT levels, regardless of the persistence of fluid collections. We found PCT to be a useful aid in the medical decision-making process to safely discontinue antimicrobial therapy in a series of patients with persistent intra-abdominal collections despite early drainage and appropriate course of antimicrobial therapy

Introduction

Methods

31 Male Black

Discussion

Findings

Conclusions