Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 25 , ISSUE 5 ( May, 2021 ) > List of Articles

ORIGINAL RESEARCH

Serum Procalcitonin as a Biomarker to Determine the Duration of Antibiotic Therapy in Adult Patients with Sepsis and Septic Shock in Intensive Care Units: A Prospective Study

SM Gowri Vishalashi, Pardeep Kumar Verma

Citation Information : Vishalashi SG, Verma PK. Serum Procalcitonin as a Biomarker to Determine the Duration of Antibiotic Therapy in Adult Patients with Sepsis and Septic Shock in Intensive Care Units: A Prospective Study. Indian J Crit Care Med 2021; 25 (5):507-511.

DOI: 10.5005/jp-journals-10071-23802

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Background: Procalcitonin, a biomarker to adjudge the duration of antibiotic therapy in patients with sepsis. Materials and methods: A prospective, randomized, controlled, interventional, single-center study was conducted in a mixed adult intensive care unit (ICU). In a nonblinded study, 90 adult patients admitted to the ICU with sepsis and septic shock were randomized into group P (group procalcitonin) and group C (group control). The duration of antibiotic therapy was decided based on serum procalcitonin levels for patients in group P versus standard treatment protocols in group C. A procalcitonin value of <0.01 ng/mL or a subsequent decline of >80% from the baseline was cutoff and chosen to stop the antibiotic therapy. The primary aim was to compare the duration of antibiotic therapy (in days) in the two groups. The secondary objective was to compare and assess the length of ICU stay, reinfection, secondary infection rate, readmission rate, and mortality among the groups. Results: The mean duration of antibiotic therapy was significantly lesser in patients in group P (4.98 ± 2.56 vs 7.73 ± 3.06 days, p < 0.001). Patients in group C spent more days in ICU (8.80 ± 3.35 vs 5.98 ± 2.73 days, p < 0.001). The secondary infection rate was significantly higher in group C (26.7% vs 4.4%, p = 0.014). Readmission and mortality rates were comparable between the groups. Conclusion: Serum procalcitonin-based algorithm in critically ill patients with sepsis could lead to a reduction in the duration of antibiotic therapy, ICU stay, and associated morbidities like secondary infection rates. It further promotes antibiotic stewardship without any adverse effects on the patient's outcome.


HTML PDF Share
  1. De Jong E, van Oers J, Beishuizen A, Vos P, Vermeijden W, Haas L, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis 2016;16:819–827. DOI: 10.1016/S1473-3099(16)00053-0.
  2. Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA 2009;302:1059–1066. DOI: 10.1001/jama.2009.1297.
  3. Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health 2015;109:309–318. DOI: 10.1179/2047773215Y.0000000030.
  4. Huttner A, Harbarth S, Carlet J, Cosgrove S, Goossens H, Holmes A, et al. Antimicrobial resistance: a global view from the 2013 World Healthcare-Associated Infections Forum. Antimicrob Resist Infect Control 2013;2:31. DOI: 10.1186/2047-2994-2-31.
  5. Rhee C, Jones TM, Hamad Y, Pande A, Varon J, O’Brien C, et al. Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals. JAMA Netw Open 2019;2:e187571. DOI: 10.1001/jamanetworkopen.2018.7571.
  6. Shorr AF, Micek ST, Welch EC, Doherty JA, Reichley RM, Kollef MH. Inappropriate antibiotic therapy in Gram-negative sepsis increases hospital length of stay. Crit Care Med 2011;39:46–51. DOI: 10.1097/CCM.0b013e3181fa41a7.
  7. Vincent JL, Teixeira L. Sepsis biomarkers. Value and limitations. Am J Resp Crit Care Med 2014;190:1081–1082. DOI: 10.1164/rccm.201410-1895ED.
  8. Nargis W, Ibrahim M, Ahamed BU. Procalcitonin versus C-reactive protein: usefulness as biomarker of sepsis in ICU patient. Int J Crit Illn Inj Sci 2014;4:195–199. DOI: 10.4103/2229-5151.141356.
  9. Müller B, Becker KL, Schächinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000;28:977-983. DOI: 10.1097/00003246-200004000-00011.
  10. Nobre V, Harbarth S, Graf J, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients. Am J Respir Crit Care Med 2008;177;498–505. DOI: 10.1164/rccm.200708-1238OC.
  11. Shehabi Y, Sterba M, Garrett PM, Rachakonda KS, Stephens D, Harrigan P, et al. Procalcitonin algorithm in critically ill adults with undifferentiated infection or suspected sepsis. A randomized controlled trial. Am J Respir Crit Care Med 2014;190:1102–1110. DOI: 10.1164/rccm.201408-1483OC.
  12. Boudama L, Luyt C, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 2010;375:463–474. DOI: 10.1016/S0140-6736(09)61879-1.
  13. Schuetz P, Birkhahn R, Sherwin R, Jones A, Singer A, Kline J, et al. Serial procalcitonin predicts mortality in severe sepsis patients. Crit Care Med 2017;45:781–789. DOI: 10.1097/CCM.0000000000002321.
  14. Stolz D, Smyrnios N, Eggimann P, Pargger H, Thakkar N, Siegemund M, et al. Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study. Eur Respir J 2009;34:1364–1375. DOI: 10.1183/09031936.00053209.
  15. Jensen JU, Hein L, Lundgren B, Bestle MH, Mohr TT, Andersen MH, et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Crit Care Med 2011;39:2048–2058. DOI: 10.1097/CCM.0b013e31821e8791.
  16. Bloos F, Trips E, Nierhaus A, Briegel J, Heyland DK, Jaschinski U, et al. Effect of sodium selenite administration and procalcitonon-guided therapy on mortality in patients with severe sepsis or septic shock A randomized clinical trial. JAMA Intern Med 2016;176:1266–1276. DOI: 10.1001/jamainternmed.2016.2514.
  17. Townsend J, Adams V, Galiatsatos, Pearse D, Pantle H, Masterson M, et al. Procalcitonin-guided antibiotic therapy reduces antibiotic use for lower respiratory tract infections in a United States medical center: results of a clinical trial. Open Forum Infect Dis 2018;5:ofy327. DOI: 10.1093/ofid/ofy327.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.