New Sepsis Treatment Reduces Length of Time in ICU

According to a recent article in the American
Journal of Respiratory and Clinical Care Medicine
ICU stays, treatment duration, and hospital costs may be reduced
if a blood test and a decision algorithm are used to determine how long
patients with severe sepsis or septic shock should receive antibiotic
therapy. The report by Swiss researchers suggests using the blood test
and
decision algorithm rather than standard hospital protocols and
maintains that there are no adverse effects on patients.

Researcher Jérôme Pugin, M.D. (Intensive Care Unit at the
University Hospital in Geneva, Switzerland) notes that: “We have shown
that it is possible to customize antibiotic treatment
duration in patients with septicemia based on a reliable and robust
blood test.”

Pugin and colleagues randomly assigned 79 patients to receive
antibiotics either a) according to standard
hospital protocols and physician administration or b)
according to a
decision algorithm that uses the procalcitonin (PCT) levels in the
blood. Procalcitonin is a marker that indicates bacterial infections in
patients who possibly have sepsis. Participants in the PCT treatment
group should have stopped receiving antibiotics according to
circulating PCT levels. At these stopping points, researchers suggested
that the treating physicians stop antibiotic therapy, but ultimately
the attending physician made all final treatment decisions.

Patients who were in the PCT group received 3.5 fewer days of
antibiotic therapy than the control group, but the difference was not
significant when analyzing all 79 participants. After controlling for
early drop-outs, infections that were previously undiagnosed,
and
patients whose physicians who did not halt antibiotic treatment
according to the algorithm, the researchers determined that PCT
patients had a significantly shorter
treatment time at 6 days compared to control group patients who
averaged 12.5 days on antibiotics.

Pugin notes that this researche is the “first randomized clinical
trial in which a surrogate
biochemical parameter was used to reduce the duration of antibiotic
therapy in a population of critically ill patients admitted to the ICU
for severe sepsis and septic shock.” Although there was a somewhat
short treatment time in bacteremic patients in the PCT group, “no case
of recurrence of infection was observed in
these patients.”

In addition, patients with PCT treatment stayed in ICU three days
compared to five days for control group patients, a significantly
shorter length of time.

Pugin adds that the treatment based on PCT levels not only can save
hospitals money and reduce the length of ICU stays, but it can reduce
the likelihood of antibiotic resistance due to overuse. “Overuse of
antibiotics can result in antibiotic resistance.”Given the diversity
of the types of infections, bacterial strains and levels of host immune
defense, every infected patient should benefit from a personalized
treatment, and particularly, a personalized treatment duration,” he
notes.

Hoping that these customized treatments will become internationally
available, the researchers wish to improve sepsis care around the
world. “We have now
implemented this new algorithm based on procalcitonin guidance in our
ICU for patients presenting with severe sepsis and septic shock, and
are following the outcome of those patients,” writes Dr. Pugin.
“Currently, three large multi-center trials are ongoing in France,
Denmark and Germany, with a design similar to that of our study.
Results from these studies will be important to determine whether such
a protocol of procalcitonin guidance is definitely safe and can be
generalized worldwide.”

Use of Procalcitonin to Shorten Antibiotic Treatment Duration
in Septic
Patients

Vandack Nobre, Stephan Harbarth, Jean-Daniel Graf, Peter Rohner, and
Jérôme Pugin
American Journal of Respiratory and Critical Care Medicine
(2007). 177: 498-505
doi:10.1164/rccm.200708-1238OC
Click
Here to View Abstract

Written by: Peter M Crosta

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