Research Article
Satoshi Takeda*, Nobuhiko N
Abstract
Background: The optimal duration of antibiotic treatment has not been established for pneumonia patients.Methods: We retrospectively enrolled hospitalized community-acquired or healthcare-associated pneumoniapatients in whom antibiotics were discontinued on the day or next day of procalcitonin (PCT) measurement between2014 and 2017 (PCT-guided group, n=272). During the period, PCT was measured serially, and physicians wereencouraged to discontinue antibiotics according to the predefined PCT levels. The remaining patients admittedduring the same period were included as control 1 (n=133). Those admitted between 2010 and 2014, during whichperiod PCT was not measured serially, were also included in the study as control 2 (n=287). Primary endpoints wereduration of antibiotic treatment and recurrence of pneumonia within 30 days after antibiotic discontinuation.Results: Though PCT-guided group included significantly more severe pneumonia patients than control 1 group(p<0.001), duration of antibiotic treatment of the former (median 8.0 days) was not significantly different from thelatter (median 9.0 days, p=0.9043). While pneumonia severity was not different between the PCT-guided and control2 groups, duration of antibiotic treatment of the former was significantly shorter than that of the latter (median10.0 days, p<0.001). Multivariable regression analysis revealed that PCT-guided antibiotic discontinuation wassignificantly related to duration of antibiotic treatment in both of PCT-guided and control 1 groups (p=0.0131), andPCT-guided and control 2 groups (p<0.001). Pneumonia recurrence within 30 days after antibiotic discontinuationof PCT-guided group (6.6%) was not statistically different from control 1 (3.0%) and 2 (5.9%) groups, respectively.Analysis regarding pneumonia patients with low PCT levels on admission revealed similar results.Conclusion: PCT-guided antibiotic discontinuation might be useful for shortening the duration of antibiotictreatment without increasing pneumonia recurrence in daily clinical practice irrespective of PCT levels on admission