Monitoring both procalcitonin and C-reactive protein in the early period after tetralogy of Fallot correction in children promotes rational antibiotic use

Jaworski, Radosław; Haponiuk, Ireneusz; Irga‐Jaworska, Ninela; Steffens, Mariusz; Chojnicki, Maciej; Paczkowski, Konrad; Zieliński, Jacek

doi:10.1016/j.advms.2017.10.003

Cited by 7 publications

(6 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 21 studies were included in the pooled analyses 5,15–19,21–35 . Data were collected for the following timepoints: pre‐CPB, end of CPB, 1 h after CPB, POD 1, POD 2, POD 3, POD 4, and POD 5.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 21 studies were included in the pooled analyses. 5,[15][16][17][18][19][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Data were collected for the following timepoints: pre-CPB, end of CPB, 1 h after CPB, POD 1, POD 2, POD 3, POD 4, and POD 5. Figure 1 outlines the study search strategy while Table 1 provides an overview of included studies.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

Farias

Villarreal

Dhargalkar

et al. 2021

Journal of Cardiac Surgery

View full text Add to dashboard Cite

Introduction To assess the efficacy of C‐reactive protein (CRP) and procalcitonin (PCT) at identifying infection in children after congenital heart surgery (CHS) with cardiopulmonary bypass (CPB). Materials and Methods Systematic review of the literature was conducted to identify studies with data regarding CRP and/or PCT after CHS with CPB. The primary variables identified to be characterized were CRP and PCT at different timepoints. The main inclusion criteria were children who underwent CHS with CPB. Subset analyses for those with and without documented infection were conducted in similar fashion. A p value of less than .05 was considered statistically significant. Results A total of 21 studies were included for CRP with 1655 patients and a total of 9 studies were included for PCT with 882 patients. CRP peaked on postoperative Day 2. A significant difference was noted in those with infection only on postoperative Day 4 with a level of 53.60 mg/L in those with documented infection versus 29.68 mg/L in those without. PCT peaked on postoperative Day 2. A significant difference was noted in those with infection on postoperative Days 1, 2, and 3 with a level of 12.9 ng/ml in those with documented infection versus 5.6 ng/ml in those without. Conclusions Both CRP and PCT increase after CHS with CPB and peak on postoperative day 2. PCT has a greater statistically significant difference in those with documented infection when compared to CRP and a PCT of greater than 5.6 ng/ml should raise suspicion for infection.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

Farias

Villarreal

Dhargalkar

et al. 2021

Journal of Cardiac Surgery

View full text Add to dashboard Cite

show abstract

“…After a careful search for references, we identified an additional 8 of 48 papers relevant for the analysis. After the removal of duplicates, exclusion of reports other than original papers or reviews, and reports that did not fulfill the inclusion criteria, we identified 20 publications for the final analysis [1][2][3][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Detailed information included in these 20 papers is provided in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Jaworski

Kansy

Dzierżanowska-Fangrat

et al. 2019

Surgical Infections

Self Cite

View full text Add to dashboard Cite

Background: Prophylactic antibiotic therapy is given routinely in the peri-operative period to prevent surgical site infection. However, in pediatric cardiac surgery, an optimal schedule has not been defined. Pediatric recommendations follow the guidelines for adults, which might be improper because of the inherent challenges in pediatric research and the heterogeneity of the population. Implementation of an effective prophylaxis protocol is needed for children undergoing cardiac surgery, especially in view of worldwide antibiotic overuse and the development of drug resistance. In this review, we analyze the current knowledge supported by up-todate publications about antibiotic prophylaxis in pediatric cardiac surgery. Methods: The PubMed Ò database was searched for full-text journal articles describing peri-operative antibiotic prophylaxis in pediatric cardiac surgery published since 2000. Antibiotics used for standard prophylaxis with dosing schema, time of the first dose, additional dosage in extracorporeal circulation (ECC) priming, and prophylaxis duration were analyzed. Additionally, we looked for special clinical situations such as antibiotic prophylaxis in children with the sternum left open after surgery and patients with b-lactam allergy or preoperative methicillin-resistant Staphylococcus aureus (MRSA) colonization or those requiring extracorporeal membrane oxygenation (ECMO). Results: A total of 1,546 articles were evaluated, and we identified 20 for further analysis. On the basis of the current peri-operative antibiotic prophylaxis recommendations for cardiac surgery and the papers reviewed, we tried to propose a schedule for peri-operative antibiotic prophylaxis in pediatric cardiac surgery. Conclusions: There is a need for careful use and examination of the schedule proposed because the pharmacokinetics of antibiotics in pediatric patients with ECC is not fully understood. This should be evaluated further. Formulating uniform recommendations concerning peri-operative antibiotic prophylaxis is difficult.

show abstract

“…No increase in complications or adverse outcomes was detected. There are no published studies about the use of PCT-guided protocols in children after CVS, although preliminary published results seem to indicate that the use of PCT could reduce the exposure to antibiotics in these patients [34].…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin to stop antibiotics after cardiovascular surgery in a pediatric intensive care unit—The PROSACAB study

et al. 2019

View full text Add to dashboard Cite

Introduction and objectiveChildren admitted to the pediatric intensive care unit after cardiovascular surgery usually require treatment with antibiotics due to suspicion of infection. The aim of this study was to assess the effectiveness of procalcitonin in decreasing the duration of antibiotic treatment in children after cardiovascular surgery.MethodsProspective, interventional study carried out in a pediatric intensive care unit. Included patients under 18 years old admitted after cardiopulmonary bypass. Two groups were compared, depending on the implementation of the PCT-guided protocol to stop or de-escalate the antibiotic treatment (Group 1, 2011–2013 and group 2, 2014–2018). This new protocol was based on the decrease of the PCT value by 20% or 50% with respect to the maximum value of PCT. Primary endpoints were mortality, stewardship indication, duration of antibiotic treatment, and antibiotic-free days.Results886 patients were recruited. There were 226 suspicions of infection (25.5%), and they were confirmed in 38 cases (16.8%). The global rate of infections was 4.3%. 102 patients received broad-spectrum antibiotic (4.7±1.7 days in group 1, 3.9±1 days in group 2 with p = 0.160). The rate of de-escalation was higher in group 2 (30/62, 48.4%) than in group 1 (24/92, 26.1%) with p = 0.004. A reduction of 1.1 days of antibiotic treatment (group 1, 7.7±2.2 and group 2, 6.7±2.2, with p = 0.005) and 2 more antibiotic free-days free in PICU in group 2 were observed (p = 0.001), without adverse outcomes.ConclusionsProcalcitonin-guided protocol for stewardship after cardiac surgery seems to be safe and useful to decrease the antibiotic exposure. This protocol could help to reduce the duration of broad-spectrum antibiotics and the duration of antibiotics in total, without developing complications or adverse effects.

show abstract

Monitoring both procalcitonin and C-reactive protein in the early period after tetralogy of Fallot correction in children promotes rational antibiotic use

Cited by 7 publications

References 24 publications

C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

C‐reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried?

Antibiotic Prophylaxis in Pediatric Cardiac Surgery: Where Are We and Where Do We Go? A Systematic Review

Procalcitonin to stop antibiotics after cardiovascular surgery in a pediatric intensive care unit—The PROSACAB study

Contact Info

Product

Resources

About