Precalcitonin and C-reactive protein as markers in response to antibiotic treatment in ventilator-associated pneumonia in intensive care unit-hospitalized patients


1 Department of Anesthesiology and Intensive Care, Anesthesiology and Critical Care Research Center, Isfahan, Iran

2 Department of Pulmonology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran


Background: Pneumonia due to ventilator is a prevalent nosocomial infection associated with high morbidity and mortality. This study aimed to determine the change in serum levels of precalcitonin (PCT) and C-reactive protein (CRP) in response to antibiotic treatment in patients hospitalized in intense care unit (ICU) suffering from ventilator-associated pneumonia (VAP).
Materials and Methods: This is an analytical and descriptive study performed in 2013 in Ayatollah Kashani Medical Training Center, Isfahan, Iran. The statistical sample includes patients hospitalized in ICU in 2013 suffering from VAP. In this study, 50 patients suffering from VAP were selected, and PCT and CRP levels were measured in them before antibiotic therapy and every 48 h until the end of therapy. The collected data were analyzed by SPSS software.
Results: CRP and PCT levels were high before the beginning of antibiotic therapy in all patients suffering from VAP and their CRP level had an increasing trend until 4 days after the beginning of therapy; however, from the 4th day, it turned into decreasing trend. PCT serum level was higher than normal before the treatment and until 48 h after the therapy, and then it was found to have a decreasing trend. According to variance analysis test with repetition of observations, the mean level of mentioned markers had a meaningful difference before the beginning of antibiotic therapy until the end of antibiotic therapy (P < 0.001).
Conclusion: CRP and PCT serum levels can be used as an instrument for determining the effect of antibiotic therapy in patients with VAP.


Ghazvini K, Ghanaat J, Jafarian MM, Yazdan Panah M, Irani N. Incidence of nosocomial pneumonia and bacterial agents causing this infection in intensive care unit in Qaem university hospital in Mashhad. J Ilam Univ Med Sci 2005;13:55-61.  Back to cited text no. 1
Nassaji M, Mousavi SH, Ghorbani R. Incidences of nosocomial pneumonia in patients above 15 years in intensive care units of university hospital in Semnan. Koomesh J Semnan Univ Med Sci 2003;2:87-92.  Back to cited text no. 2
Joseph NM, Sistla S, Dutta TK, Badhe AS, Parija SC. Ventilator-associated pneumonia in a tertiary care hospital in India: Incidence and risk factors. J Infect Dev Ctries 2009;3:771-7.  Back to cited text no. 3
Gopal Katherason S, Naing L, Jaalam K, Imran Musa K, Nik Mohamad NA, Aiyar S, et al. Ventilator-associated nosocomial pneumonia in intensive care units in Malaysia. J Infect Dev Ctries 2009;3:704-10.  Back to cited text no. 4
Apostolopoulou E, Bakakos P, Katostaras T, Gregorakos L. Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece. Respir Care 2003;48:681-8.  Back to cited text no. 5
da Silva JM Jr, Rezende E, Guimarães T, dos Campos EV, Magno LA, Consorti L, et al. Epidemiological and microbiological analysis of ventilator-associated pneumonia patients in a public teaching hospital. Braz J Infect Dis 2007;11:482-8.  Back to cited text no. 6
Sadeghi M, Asghazadeh SA, Baratlu AR, Montazeri M. Antibiotic resistance pattern of gram negative bacillus isolated from respiratory culture in Intensive Care Unit's patients of Yahyanejad hospital. J Infect Dis Trop Med 2009;14:39-43.  Back to cited text no. 7
Hillas G, Vassilakopoulos T, Plantza P, Rasidakis A, Bakakos P. C-reactive protein and procalcitonin as predictors of survival and septic shock in ventilator-associated pneumonia. Eur Respir J 2010;35:805-11.  Back to cited text no. 8
Ramirez P, Garcia MA, Ferrer M, Aznar J, Valencia M, Sahuquillo JM, et al. Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia. Eur Respir J 2008;31:356-62.  Back to cited text no. 9
Luyt CE, Guérin V, Combes A, Trouillet JL, Ayed SB, Bernard M, et al. Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med 2005;171:48-53.  Back to cited text no. 10
Saberi M, Shiri H, Moradians V, Taqadosi M. The investigation of the frequency of risk factors of early ventilator-associated pneumonia in ICU of Shahid Beheshti Hospital during 2009- 2010. J Feiz Sci Res2012;16:560-9.  Back to cited text no. 11
Zadeh AA, Pour FL, Delpisheh A, Janmardi R. The investigation of the incidence of ventilator associated pneumonia and its bacterial resistance in ICU for adults hospitalized in Besat hospital of Sanandaj. J Med Sci Kurdistan 2011, 16:20-206.  Back to cited text no. 12
Póvoa P, Coelho L, Almeida E, Fernandes A, Mealha R, Moreira P, et al. C-reactive protein as a marker of ventilator-associated pneumonia resolution: A pilot study. Eur Respir J 2005;25:804-12.  Back to cited text no. 13