评估降钙素原指导管理对脓毒症危重癌症患者抗生素治疗持续时间的影响。随机、对照、单盲试验。约旦一家综合性多学科癌症医院。在 ICU 接受治疗的癌症成人患者因疑似感染而使用抗生素，符合 SEPSIS-3 标准，预计在 ICU 停留时间大于或等于 48 小时。患者被随机分配到降钙素原指导组或标准护理 (SC) 组。所有患者每天测量降钙素原，持续 5 天或直到 ICU 出院或死亡。对于降钙素原组，提供了降钙素原引导的算法来指导抗生素管理，但如果有临床指示，临床医生可以推翻该算法。在 SC 组中，ICU 临床医生对降钙素原水平不知情。主要结果是停止抗生素的时间。我们还评估了 28 天时未使用抗生素的天数、出院数或死亡数（以先到者为准），以及抗生素规定每日剂量 (DDD)。我们入组了 77 名降钙素原组患者和 76 名 SC 组患者。平均年龄为 58±14 (sd) 岁，67% 为男性，74% 患有实体瘤，13% 患有中性粒细胞减少症。中位数（四分位距 [IQR]）序贯器官衰竭评估评分为 7 (6-10) 和 7 (5-9)，基线降钙素原浓度 (ng/mL) 为 3.4 (0.8-16) 和 3.4 (0.5-26) ），分别在降钙素原和 SC 组中。降钙素原组和 SC 组的中位 (IQR) 停止抗生素时间没有差异，分别为 8 (4-11) 和 8 (5-13) (p = 0.463)。降钙素原组和 SC 组的中位无抗生素天数 (IQR) 分别为 20 (17-24) 和 20 (16-23) (p = 0.484)，总 DDD 分别为 1541.4 和 2050.4。对于脓毒症患者，降钙素原指导的治疗并没有减少抗生素治疗的持续时间。版权所有 © 2024 作者。由 Wolters Kluwer Health, Inc. 代表重症监护医学协会出版。

To evaluate the effect of procalcitonin-guided management on the duration of antibiotic therapy in critically ill cancer patients with sepsis.Randomized, controlled, single-blinded trial.A comprehensive multidisciplinary cancer hospital in Jordan.Adults with cancer treated in the ICU who were started on antibiotics for suspected infection, met the SEPSIS-3 criteria, and were expected to stay in the ICU greater than or equal to 48 hours.Patients were randomized to the procalcitonin-guided or standard care (SC) arms. All patients had procalcitonin measured daily, up to 5 days or until ICU discharge or death. For the procalcitonin arm, a procalcitonin-guided algorithm was provided to guide antibiotic management, but clinicians were allowed to override the algorithm, if clinically indicated. In the SC arm, ICU clinicians were blinded to the procalcitonin levels.Primary outcome was time to antibiotic cessation. We also evaluated the number of antibiotic-free days at 28 days, hospital discharge, or death, whichever came first, and antibiotic defined daily doses (DDDs). We enrolled 77 patients in the procalcitonin arm and 76 in the SC arm. Mean age was 58 ± 14 (sd) years, 67% were males, 74% had solid tumors, and 13% were neutropenic. Median (interquartile range [IQR]) Sequential Organ Failure Assessment scores were 7 (6-10) and 7 (5-9) and procalcitonin concentrations (ng/mL) at baseline were 3.4 (0.8-16) and 3.4 (0.5-26), in the procalcitonin and SC arms, respectively. There was no difference in the median (IQR) time to antibiotic cessation in the procalcitonin and SC arms, 8 (4-11) and 8 (5-13), respectively (p = 0.463). Median (IQR) number of antibiotic-free days were 20 (17-24) and 20 (16-23), (p = 0.484) and total DDDs were 1541.4 and 2050.4 in the procalcitonin and SC arms, respectively.In critically ill cancer patients with sepsis, procalcitonin-guided management did not reduce the duration of antibiotic treatment.Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.