Procalcitonin-guided antibiotic therapy for suspected and confirmed sepsis of patients in a surgical trauma ICU: a prospective, two period cross-over, interventional study

Chomba, Rispah; Moeng, Maeyane Stephens; Lowman, Warren

doi:10.17159/2078-5151/2020/v58n3a3341

Cited by 8 publications

(15 citation statements)

References 20 publications

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“…We reviewed 15 research papers with a total of 3,484 postoperative patients. Out of these finalized studies, two were systematic reviews and meta-analyses [21,22], two were narrative reviews [23,24], one was a nonrandomized clinical trial, and the remaining nine were observational studies [10][11][12][13][14][15][16][17][18][19], and one nonrandomized interventional study [20]. All studies involved operated patients and the measurement of CRP and PCT postoperatively during their in-hospital/ICU stay and their role in patients developing sepsis and SIRS.…”

Section: Study Characteristicsmentioning

confidence: 99%

Role of Procalcitonin and C-reactive Protein as Predictors of Sepsis and in Managing Sepsis in Postoperative Patients: A Systematic Review

Hassan¹,

Khan²,

Zahra³

et al. 2022

Cureus

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Systemic inflammatory response syndrome (SIRS) and sepsis are inflammatory responses to infection or trauma, causing symptoms and adverse outcomes such as organ shutdown and death. Different scoring systems can help in the diagnosis of SIRS and sepsis. Several biomarkers such as C-reactive protein (CRP), procalcitonin (PCT), and white blood cells (WBCs) can serve as predictors of sepsis. Surgery, trauma, and burns are the non-inflammatory causes of SIRS and sepsis. In postoperative patients, both inflammatory and non-inflammatory causes of immune response may co-exist. The role of inflammatory biomarkers in identifying sepsis development, deciding to use antibiotics, and discharging patients needs further exploration and clarity. We searched medical databases such as PubMed/Medline, PMC, ScienceDirect, Cochrane Library, and Google Scholar for relevant medical literature. The identified papers were screened, eligibility criteria were applied, and 15 research papers were identified. The finalized papers explored the roles of CRP and PCT in postoperative patients. Both CRP and PCT are raised in a postoperative patient, and then, gradually, the levels decrease. However, in case of an infection, these levels continue to rise and signify an infection, which may progress to sepsis. The cut-off values can guide decision-making about when to start antibiotics and discharge the patient. PCT was found to be more reliable in identifying the infection and preventing the development of sepsis. Further research is needed to identify the exact cut-off values that can help in decision-making.

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Section: Study Characteristicsmentioning

confidence: 99%

Role of Procalcitonin and C-reactive Protein as Predictors of Sepsis and in Managing Sepsis in Postoperative Patients: A Systematic Review

Hassan¹,

Khan²,

Zahra³

et al. 2022

Cureus

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“…The benefit disclosed by the larger ProHOSP and SAPS trial was further corroborated by smaller studies from developing countries [49][50][51] and meta-analyses [54][55][56][57][58][59][60][61][62]. A first meta-analysis was published in 2018 including a total of 4482 ICU patients and subanalyzing patients meeting Sepsis-3 criteria [58].…”

Section: Antimicrobial Stewardship Through Pct-guidance In Sepsismentioning

confidence: 94%

“…Critically ill and sepsis patients are the next most commonly studied population for benefit following PCT-guidance [32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. The efficacy of existing trials is summarized in Table 2.…”

Section: Antimicrobial Stewardship Through Pct-guidance In Sepsismentioning

confidence: 99%

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Kyriazopoulou

Giamarellos‐Bourboulis

2022

Antibiotics

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This review aims to summarize current progress in the management of critically ill, using biomarkers as guidance for antimicrobial treatment with a focus on antimicrobial stewardship. Accumulated evidence from randomized clinical trials (RCTs) and observational studies in adults for the biomarker-guided antimicrobial treatment of critically ill (mainly sepsis and COVID-19 patients) has been extensively searched and is provided. Procalcitonin (PCT) is the best studied biomarker; in the majority of randomized clinical trials an algorithm of discontinuation of antibiotics with decreasing PCT over serial measurements has been proven safe and effective to reduce length of antimicrobial treatment, antibiotic-associated adverse events and long-term infectious complications like infections by multidrug-resistant organisms and Clostridioides difficile. Other biomarkers, such as C-reactive protein and presepsin, are already being tested as guidance for shorter antimicrobial treatment, but more research is needed. Current evidence suggests that biomarkers, mainly procalcitonin, should be implemented in antimicrobial stewardship programs even in the COVID-19 era, when, although bacterial coinfection rate is low, antimicrobial overconsumption remains high.

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“…The search strategy yielded 26 studies examining PCT in critically ill patients with infection. Fourteen prospective interventional trials, [13][14][15][16][17][18][19][20][21][22][23][24][25][26] and six meta-analyses addressed the use of PCT and clinical outcomes in critically ill patients with sepsis. [27][28][29][30][31][32] Five trials examined the prognostic use of PCT in critically ill patients.…”

Section: Proc Alcitonin Monitoring In Critic Ally Ill Patients With I...mentioning

confidence: 99%

Biomarkers in the intensive care setting: A focus on using procalcitonin and C‐reactive protein to optimize antimicrobial duration of therapy

et al. 2023

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Managing the critically ill patient with infection is complex, requiring clinicians to synthesize considerable information relating to antimicrobial efficacy and treatment duration. The use of biomarkers may play an important role in identifying variation in treatment response and providing information about treatment efficacy. Though a vast number of biomarkers for clinical application have been described, procalcitonin and C‐reactive protein (CRP) are the most thoroughly investigated in the critically ill. However, the presence of heterogeneous populations, variable end points, and incongruent methodology in the literature complicates the use of such biomarkers to guide antimicrobial therapy. This review focuses on an appraisal of evidence for use of procalcitonin and CRP to optimize antimicrobial duration of therapy (DOT) in critically ill patients. Procalcitonin‐guided antimicrobial therapy in mixed critically ill populations with varying degrees of sepsis appears to be safe and might assist in reducing antimicrobial DOT. Compared to procalcitonin, fewer studies exist examining the impact of CRP on antimicrobial DOT and clinical outcomes in the critically ill. Procalcitonin and CRP have been insufficiently studied in many key intensive care unit populations, including surgical patients with concomitant trauma, renally insufficient populations, the immunocompromised, and patients with septic shock. We believe the available evidence is not strong enough to warrant routine use of procalcitonin or CRP to guide antimicrobial DOT in critically ill patients with infection. So long as its limitations are recognized, procalcitonin could be considered to tailor antimicrobial DOT on a case‐by‐case basis in the critically ill patient.

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Procalcitonin-guided antibiotic therapy for suspected and confirmed sepsis of patients in a surgical trauma ICU: a prospective, two period cross-over, interventional study

Cited by 8 publications

References 20 publications

Role of Procalcitonin and C-reactive Protein as Predictors of Sepsis and in Managing Sepsis in Postoperative Patients: A Systematic Review

Role of Procalcitonin and C-reactive Protein as Predictors of Sepsis and in Managing Sepsis in Postoperative Patients: A Systematic Review

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Biomarkers in the intensive care setting: A focus on using procalcitonin and C‐reactive protein to optimize antimicrobial duration of therapy

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