PROCALCIITONIIN IIN REDUCIING THE DURATIION OF ANTIIBIIOTIIC THERAPY IIN SEPTIIC CRIITIICALLY IILL PATIIENTS

Abstract

The duration of antibiotic therapy in critically ill patients with sepsis is based on empirical rules which can result in antibiotic overuse, increasing the risk of developing multi-drug resistant (MDR) pathogens, nosocomial superinfections and excess cost. Newer strategies aimed at identifying patients most likely to benefit from antibiotics and those that may require shorter than standard treatments using clinical biomarkers to assess presence, severity, and progression of disease like C-reactive protein (CRP), white blood cell count (WBC), interleukins (IL) and most recently, procalcitonin (PCT) has become a target tool to improve antimicrobial stewardship. Procalcitonin (PCT), the biologically active precursor of the calcium-modulating hormone calcitonin has been shown in diverse studies to be closely associated with the human host response to bacterial infection. It is elaborated by parenchymal cells throughout the body in response to endotoxin and several pro-inflammatory mediators (in particular TNF-α) and its concentration appears to be roughly linear with the degree of insult. It has tantalizing characteristics as a biomarker for bacterial infection, showing diagnostic superiority to white cell count, C-reactive protein, and a host of physiologic variables in most reports. Our study was conducted on a total of 50 patients requiring antibiotic therapy based on confirmed or highly suspected bacterial infections who are matching the inclusion criteria assigned randomly to 2 groupseach containing 25 patients. 25 patients will receive antibiotics according to serum procalcitonin guidance (Group P-PCT guided group) while the other 25 patients will receive antibiotics according to our ICU protocol (Group C-control group). Our results favors using PCT algorithm as a guidance in antibiotic duration of therapy as it allows shorter duration of stay in the intensive care and shorter duration of antibiotics days of therapy without affecting the outcome of therapy regarding clinical cure or mortality rate. Our data support the concept that PCT guidance allows reducing antibiotic exposure in critically ill patients with severe sepsis and septic shock, and that this strategy is not associated with worse outcomes.