Procalcitonin-guided algorithm to reduce length of antibiotic therapy in patients with severe sepsis and septic shock

Abstract

BackgroundProcalcitonin (PCT)-protocols to guide antibiotic treatment in severe infections are known to be effective. But less is known about the long-term effects of such protocols on antibiotic consumption under real life conditions. This retrospective study analyses the effects on antibiotic use in patients with severe sepsis and septic shock after implementation of a PCT-protocol.MethodsWe conducted a retrospective ICU-database search for adult patients between 2005 and 2009 with sepsis and organ dysfunction who where treated accordingly to a PCT-guided algorithm as follows: Daily measurements of PCT (BRAHMS PCT LIA®; BRAHMS Aktiengesellschaft, Hennigsdorf, Germany). Antibiotic therapy was discontinued if 1) clinical signs and symptoms of infection improved and PCT decreased to ≤1 ng/ml, or 2) if the PCT value was >1 ng/ml, but had dropped to 25-35% of the initial value within three days. The primary outcome parameters were: antibiotic days on ICU, ICU re-infection rate, 28-day mortality rate, length of stay (LOS) in ICU, mean antibiotic costs (per patient) and ventilation hours. Data from 141 patients were included in our study. Primary outcome parameters were analysed using covariance analyses (ANCOVA) to control for effects by gender, age, SAPS II, APACHE II and effective cost weight.ResultsFrom baseline data of 2005, duration of antibiotic therapy was reduced by an average of 1.0 day per year from 14.3 ±1.2 to 9.0 ±1.7 days in 2009 (p=0.02). ICU re-infection rate was decreased by yearly 35.1% (95% CI −53 to −8.5; p=0.014) just as ventilation hours by 42 hours per year (95% CI −72.6 to −11.4; p=0.008). ICU-LOS was reduced by 2.7 days per year (p<0.001). Trends towards an average yearly reduction of 28-day mortality by −22.4% (95% CI −44.3 to 8.1; p=0.133) and mean cost for antibiotic therapy/ patient by −14.3 Euro (95% CI −55.7 to 27.1) did not reach statistical significance.ConclusionsIn a real-life clinical setting, implementation of a PCT-protocol was associated with a reduced duration of antibiotic therapy in septic ICU patients without compromising clinical or economical outcomes.German clinical trials registerDRKS00003490

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

“…-Procalcitonin has been proposed as a marker of infection [60][61][62][63]. Furthermore, it may be useful as an indicator of the severity of infection and as a guide for therapy (dose de-escalation [64]) in respiratory infections [61,62,[65][66][67][68].…”

“…The use of procalcitonin [64,144,145] or similar biomarkers may facilitate discontinuance of antibiotics in a patient with clinical improvement, although one recent study failed to show any benefit of daily procalcitonin measurement [146]. Table 4) should be rapidly referred to an intensive care unit (ICU) In 2004, the "Surviving Sepsis Campaign" guidelines recommended the use of EGDT [147] based on one large randomized trial [93].…”

Analytical evaluation of the performances of Diazyme and BRAHMS procalcitonin applied to Roche Cobas in comparison with BRAHMS PCT-sensitive Kryptor

“…Various clinical cutoffs for PCT are established for various clinical settings, with higher cutoffs being used in critical care and sepsis and lower cutoffs being used in immunocompromised patients, or to guide antibiotic decisions [4]. PCT-based clinical algorithms have been proposed to guide antibiotic therapy both for patients with lower respiratory tract infections (LRTI), including pneumonia, acute exacerbations of chronic obstructive pulmonary disease and acute bronchitis as well as for critically ill patients [5][6][7][8].…”

Procalcitonin: a valuable markerfor assessment of the success of antimicrobial therapy for severe sepsis An analysis using routine clinical data

“…The measurement of a series of PCT levels has consistently been described as useful for the evaluation of therapeutic success [7,21]. Hohn et al demonstrated these effects, even among routine clinical populations [22]. In addition, numerous clinical studies have confirmed that antibiotic therapy can be stopped when PCT levels have normalized and clinical improvement has occurred, without risk of increased mortality.…”