The comparison of procalcitonin guidance in administration of antibiotic with empirical antibiotic therapy in critically ill patients with SIRS admitted in intensive care unit

Abstract

The critically ill patients with sepsis usually undergo antibiotic empirical treatment. This strategy results in antibiotic overuse and increase in the cost and bacterial resistance. These patients initially present with systemic inflammatory response syndrome (SIRS). SIRS is seen after trauma, major operation, severe inflammation and infections. Patients with SIRS undergo supportive therapy except SIRS due to an infection that is diagnosed as sepsis and needs early administration of antibiotic and control of infection. These issues lead to the development of new biomarkers that accurately predict sepsis in these patients. Previous studies have showed that serum level of procalcitonin (PCT) increased in patients with sepsis, and this marker is accurate in the diagnosis of sepsis. Normal serum levels of PCT are below 0.5 ng/mL and patients with serum levels above 2 ng/mL are more likely to develop sepsis. It was shown that PCT is a useful guide for initiation of antibiotic in patients with respiratory infection. Moreover, PCT-guided treatment can decrease the duration of antibiotic therapy in critically ill patients. Also, one study concluded that PCT guide treatment in patients with lower tract respiratory infection decreased antibiotic consumption up to 46.4% and clinical outcomes, and mortality were similar to patients who underwent empirical antibiotic treatment. The aim of this study is to evaluate the serum procalcitonin level as a guide for antibiotic prescription in critically ill patient with SIRS in intensive care unit. This randomized controlled clinical study was conducted on 72 adult patients in the intensive care unit of Ain Shams University Hospitals. Patients were divided randomly into 2 groups (36 patients in each). Group (I): included 36 patients with SIRS was received empirical antibiotic therapy (control group). Group (II): included 36 patients with SIRS were received procalcitonin guided antibiotic therapy (patients’ group).