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. Procalcitonin (PCT) is a thyroid gland prohormone, and its  serum concentration is elevated in systemic bacterial infections. The  diagnostic cut-off value of PCT in patients early after cardiac surgery  remains unclear. Objective. We investigated whether procalcitonin-guidance  could reduce antibiotic usage safely. Methods. The prospective study included  205 patients who underwent open heart surgery. The patients were randomly  assigned for procalcitonin-guided antibiotic treatment (PCT-group; n=102) or  standard care (standard group; n=103). On the basis of serum procalcitonin  concentrations, usage of antibiotics was encouraged (PCT≥0.5 ng/mL) or  discouraged. Results. A relative risk of antibiotic exposure in the standard  group compared with the PCT-group was 3.81 (95% CI=2.03-7.17; p<0.0001). The  mean cost of antibiotics per patient in procalcitonin group was €193.3±636.6  vs. €372.1±841.1 (p=0.206) in the standard group, while the mean cost per  hospital day was €8.0±18.4 vs. €17.8±36.3 (p=0.028). We found that  non-infectious complications occurred in 40/102 vs. 41/103 (p=0.592) while  infections appeared in 5/102 vs. 22/103 (p=0.001) cases. A statistically  significant difference was observed in the treatment of urinary infections  between PCT-group and standard group; 1/102 vs. 9/103 (p=0.016). In the  PCT-group, the ICU stay was 5.74±11.49 days and in the standard group  6.97±11.61 (p=0.812). The hospital stay was 12.08±11.28 vs. 12.93±10.73  (p>0.05) days, respectively. Mortality rates were equal in both groups of  patients (p=0.537). Conclusion. Procalcitonin-guided antibiotic treatment is  safe and can significantly reduce the cost of postoperative care.  Additionally, the antibiotic use during immediate postoperative course should  be timely controlled and limited to documented bacterial infections

Procalcitonin-based therapeutic strategy to reduce antibiotic use in patients after cardiac surgery: A randomized controlled trial