Procalcitonin-guided antibiotic therapy for suspected and confirmed sepsis of patients in a surgical-trauma ICU a prospective, two-period cross-over, interventional study
Procalcitonin (PCT) is a biomarker used in sepsis to guide antibiotic duration of treatment. Clinical algorithms that utilise PCT have demonstrated value in reducing duration of antibiotic treatment in critically ill patients. There is lack of evidence regarding the utility of PCT-guided antibiotic algorithms in trauma patients and in patients from developing countries. A prospective study was conducted in the surgical trauma intensive care unit (ICU) at Charlotte Maxeke Johannesburg academic hospital from April 2014 to July 2015 in a two period cross-over design. Patients with suspected or confirmed sepsis were recruited consecutively in two periods of almost equal length. In the first period, 40 patients were recruited as controls and antibiotics were discontinued as per standard of care. In the second period, 40 patients were recruited into the intervention group and antibiotics were discontinued if the PCT decreased by ≥ 80% from the peak PCT level, or to an absolute value of less than 0.5 μg/L. The antibiotic duration of treatment was the primary outcome. Patients were followed up for 28 days from the first sepsis event. For the first sepsis event the intervention group had a mean antibiotic duration of 9.3 days while the control group had a mean duration of 10.9 days (p=0.10). The mean duration of treatment was 12.0 days for a second episode of sepsis in the control group and 9.6 days in the intervention group (p=0.09). Clinician compliance to the PCT algorithm was 62.5%. The intervention group had more antibiotic free days (7.8 days) compared to the control group (3.9 days) (p=0.004). The length of ICU stay and length of hospital stay for the two groups were similar. The in-hospital mortality was reduced in the intervention group (15%) compared to the control group (30%). Our data supports the use of PCT-guided algorithms for antibiotic stewardship in surgical trauma patients. Clinician compliance would most likely increase the benefits observed in our study.
Research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine, Clinical Microbiology Johannesburg 2018