Pre-emptive antibiotic treatment vs 'standard' treatment in patients with elevated serum procalcitonin levels after elective colorectal surgery: a prospective randomised pilot study.

• Abstract: BACKGROUND: Procalcitonin (PCT) is regarded as a specific indicator of bacterial infection. Infectious complications in patients after colorectal surgery are a common cause of morbidity and mortality. The aim of this study was to investigate (a) whether PCT could serve as a negative predictive marker for postoperative complications and (b) whether, in patients with elevated PCT levels, a pre-emptive treatment with the third-generation cephalosporin ceftriaxone is superior to an antibiotic treatment starting later on the appearance of clinical signs and symptoms of infection. PATIENTS AND METHODS: By screening 250 patients with colorectal surgery, we identified 20 patients with PCT serum levels more than 1.5 ng/ml on at least 2 of the first 3 postoperative days. The remaining 230 patients were followed-up for the occurrence of infectious complications. The 20 patients with elevated PCT were included in a prospective randomised pilot study comparing pre-emptive antibiotic treatment with ceftriaxone vs standard treatment. RESULTS: The negative predictive value of PCT for systemic infectious complications was 98.3%. In patients receiving pre-emptive antibiotic treatment (ceftriaxone), both the incidence and the severity of postoperative systemic infections were significantly lower compared to those in a control group (Pearson's chi(2) test; p=0.001 and p=0.007, respectively). Major differences were also observed with respect to duration of antibiotic treatment and length of hospital stay. CONCLUSIONS: PCT is an early marker for systemic infectious complications after colorectal surgery with a high negative predictive value. A significant reduction in the rate of postoperative infections in patients with elevated PCT serum concentrations was achieved by means of pre-emptive antibiotic treatment.
• Authors: Ansgar Michael Chromik, Frank Endter, Waldemar Uhl, Arnulf Thiede, Hans Bernd Reith, Ulrich Mittelkötter (Affiliation: Department of General Surgery, University Hospital of Bochum, Bochum, Germany.)
• Journal: Langenbeck's archives of surgery / Deutsche Gesellschaft für Chirurgie (Langenbecks Arch Surg) Vol. 391 Issue 3 Pg. 187-94 (Jun 2006) ISSN: 1435-2443 [Print] Germany
• PMID: 16369855 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Anti-Bacterial Agents
• Biological Markers
• Protein Precursors
• procalcitonin
• Ceftriaxone
• Calcitonin

Topics

• Aged
• Anti-Bacterial Agents (therapeutic use)
• Antibiotic Prophylaxis
• Bacterial Infections (blood, prevention & control)
• Biological Markers (blood)
• Calcitonin (blood)
• Ceftriaxone (therapeutic use)
• Chi-Square Distribution
• Colorectal Neoplasms (blood, surgery)
• Female
• Humans
• Male
• Middle Aged
• Pilot Projects
• Postoperative Complications (blood, prevention & control)
• Predictive Value of Tests
• Prospective Studies
• Protein Precursors (blood)
• Treatment Outcome