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Discussion of Serum Procalcitonin Level on the Value of Antibiotic Treatment in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Author: ZhaoDaHai
Tutor: LiuRongYu
School: Anhui Medical University,
Course: Geriatrics
Keywords: Procalcitonin Acute exacerbation of chronic obstructive pulmonary disease Antibacterial treatment strategies
CLC: R563.9
Type: Master's thesis
Year: 2008
Downloads: 160
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Abstract


Objective To evaluate procalcitonin (Procalcitonin, PCT) to guide antimicrobial treatment strategy in acute exacerbation of chronic obstructive pulmonary disease (acute exacerbations of chronic obstructive pulmonary disease, AECOPD) to optimize the value in the use of antibiotics. Study the relationship between serum PCT levels with antibacterial treatment of bacterial infections of lower respiratory tract, specifically to determine whether the short-range antimicrobial therapy can achieve the desired therapeutic effect, in order to evaluate the serum PCT levels can become a respiratory bacterial infection under the guidance of rational use of antibiotics laboratory indicators. September 2006 to August 2007 in the elderly in our hospital Respiratory Medicine and Respiratory Diseases, specialty treatment center selected 56 cases of AECOPD patients (inclusion criteria for the date of serum the PCT> 0.25ug / L) were randomly divided into the PCT group (n = 26) and the conventional treatment group (n = 30). PCT group in the 1,5,7,10-day detection PCT level, the PCT detected by semi-quantitative immunochromatographic assay, the production was measured by Germany BRAHMS PCT-Q test card. Serum PCT levels to determine the use of antibiotics and the PCT guidance treatment strategies: the PCT concentration <0.1ug / L is considered to lack of bacterial infection, avoid the use of antibiotics; the 0.1ug / = the PCT concentrations <0.25ug / L is considered bacterial infection impossible , do not encourage the use of antibiotics; the 0.25ug / L = PCT concentrations <0.5ug / L is considered bacterial infection is possible, it is recommended that the application of antibiotics; the PCT the concentration = 0.5ug / L is that bacterial infection is present, it is strongly recommended that the use of antibiotics. The conventional treatment group to determine the use of antibiotics based on clinical symptoms. At the same time carry out the sputum bacteriology checks and other laboratory parameters such as white blood cell count (WBC), C-reactive protein (CRP). The main outcome measure was the number of days of antibiotic use, duration of hospitalization, clinical effectiveness, functional status score, increase the number of cases and number of deaths. Results The the PCT group of antibiotics distributed in 7-10 days days; most of the conventional treatment group in two weeks or longer, the difference was significant (p <0.01), the two groups of patients hospital days (p <0.01) and two re-infection of the number of cases (p <0.05) compared with a significant difference between two groups of clinical efficiency, functional status score, mortality, increasing the number of cases was no significant difference (p> 0.05). After the treatment of the two groups of patients to compare the clinical and laboratory parameters had no significant difference (p> 0.05). PCT clinical group and the conventional treatment group similar efficiency (80.77% and 76.67%, respectively, p> 0.05), functional status scores were not affected because the use of antibiotics shorten the cycle, some inflammatory markers such as white blood cell count and CRP in the treatment of after the end between the two groups were not significantly different; the PCT group hospitalization time compared to the conventional treatment group was significantly shorter (13.31 ± 7.71 days and 20.03 ± 10.60 days, respectively, p <0.01); conventional treatment group occurred superinfection The number of cases was significantly higher than the PCT group (nine cases and two cases, p <0.05). Total of seven patients in the two groups of patients overall heavier progress to severe pneumonia (PCT group three cases, the conventional treatment group, n = 4); 5 deaths, cause of death was respiratory failure and / or consolidation of Visceral disease (PCT group two cases, the conventional treatment group, n = 3). PCT group, With antibiotic use PCT levels higher than 0.25ug / L the number of people gradually reduced, the majority of patients with serum PCT levels fell below 0.25ug / L in the use of antibiotics for a week. Sputum culture bacterial positive rate procalcitonin levels unrelated (P> 0.05). According to the the Anthonisen standard genotyping, PCT levels between type Ⅰ, Ⅱ, Ⅲ type AECOPD patients no difference. Conclusions PCT guidance AECOPD antibacterial treatment to reduce antibiotic overuse, reduce superinfection opportunities. PCT as an inflammatory marker, to some extent, can guide the optimal use of antibiotics, especially AECOPD patients personalized medicine, the clinical significance of reducing bacterial resistance.

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CLC: > Medicine, health > Internal Medicine > Respiratory system and chest diseases > Pulmonary disease > Other
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