Universität zu Köln

Hohn, Andreas, Balfer, Nina, Heising, Bernhard, Hertel, Sabine, Wiemer, Jan C., Hochreiter, Marcel and Schroeder, Stefan (2018). Adherence to a procalcitonin-guided antibiotic treatment protocol in patients with severe sepsis and septic shock. Ann. Intensive Care, 8. LONDON: SPRINGEROPEN. ISSN 2110-5820

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Abstract

Background: In randomised controlled trials, procalcitonin (PCT)-guided antibiotic treatment has been proven to significantly reduce length of antibiotic therapy in intensive care unit (ICU) patients. However, concern was raised on low protocol adherence and high rates of overruling, and thus the value of PCT-guided treatment in real clinical life outside study conditions remains unclear. In this study, adherence to a PCT protocol to guide antibiotic treatment in patients with severe sepsis and septic shock was analysed. Methods: From 2012 to 2014, surgical ICU patients with severe sepsis or septic shock were retrospectively screened for PCT measurement series appropriate to make treatment decisions on antibiotic therapy We compared (1) patients with appropriate PCT measurement series to patients without appropriate series; (2) patients who reached the antibiotic stopping advice threshold (PCT < 0.5 ng/mL and/or decrease to 10% of peak level) to patients who did not reach a stopping advice threshold; and (3) patients who were treated adherently to the PCT protocol to non-adherently treated patients. The groups were compared in terms of antibiotic treatment duration, PCT kinetics, and other clinical outcomes. Results: Of 81 patients with severe sepsis or septic shock, 14 were excluded due to treatment restriction or short course in the ICU. The final analysis was performed on 67 patients Forty-two patients (62.7%) had appropriate PCT measurement series In patients with appropriate PCT series, median initial PCT (p = 0.001) and peak PCT levels (p < 0.001) were significantly higher compared to those with non-appropriate series. In 26 patients with appropriate series, PCT levels reached an antibiotic stopping advice. In 8 of 26 patients with stopping advice, antibiotics were discontinued adherently to the PCT protocol (30.8%). Patients with adherently discontinued antibiotics had a shorter antibiotic treatment (7d [IQR 6-9] vs. 12d [IQR 9-16]; p = 0. 002) No differences were seen in terms of other clinical outcomes. Conclusion: In patients with severe sepsis and septic shock, procalcitonin testing was irregular and adherence to a local PCT protocol was low in real clinical life. However, adherently treated patients had a shorter duration of antibiotic treatment without negative clinical outcomes Procalcitonin peak values and kinetics had a clear impact on the regularity of PCT testing.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hohn, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Balfer, Nina UNSPECIFIED UNSPECIFIED UNSPECIFIED Heising, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Hertel, Sabine UNSPECIFIED UNSPECIFIED UNSPECIFIED Wiemer, Jan C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hochreiter, Marcel UNSPECIFIED UNSPECIFIED UNSPECIFIED Schroeder, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-183072
DOI:	10.1186/s13613-018-0415-5
Journal or Publication Title:	Ann. Intensive Care
Volume:	8
Date:	2018
Publisher:	SPRINGEROPEN
Place of Publication:	LONDON
ISSN:	2110-5820
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTENSIVE-CARE-UNIT; C-REACTIVE PROTEIN; PROGNOSTIC VALUE; THERAPY; METAANALYSIS; ALGORITHMS; INFECTION; PNEUMONIA; MORTALITY; EXPOSURE Multiple languages Critical Care Medicine Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/18307