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
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Written by: Peter M Crosta