A Procalcitonin-Based Algorithm to Guide Antibiotic Therapy in Secondary Peritonitis following Emergency Surgery: A Prospective Study with Propensity Score Matching Analysis

BackgroundProcalcitonin (PCT)-based algorithms have been used to guide antibiotic therapy in several clinical settings. However, evidence supporting PCT-based algorithms for secondary peritonitis after emergency surgery is scanty. In this study, we aimed to investigate whether a PCT-based algorithm could safely reduce antibiotic exposure in this population.Methods/Principal FindingsFrom April 2012 to March 2013, patients that had secondary peritonitis diagnosed at the emergency department and underwent emergency surgery were screened for eligibility. PCT levels were obtained pre-operatively, on post-operative days 1, 3, 5, and 7, and on subsequent days if needed. Antibiotics were discontinued if PCT was p p p p = 0.047). Advanced age, coexisting pulmonary diseases, and higher severity of illness were significantly associated with longer durations of antibiotic use.Conclusions/SignificanceThe PCT-based algorithm safely reduces antibiotic exposure in this study. Further randomized trials are needed to confirm our findings and incorporate cost-effectiveness analysis.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12612000601831