Early procalcitonin kinetics and adequate empiric antibiotic therapy in critically ill

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Abstract in foreign language

Sepsis has become a major health economic issue, with more patients dying in hospitals due to sepsis related complications compared to breast and colorectal cancer together. Despite extensive research in order to improve outcome in sepsis over the last few decades, results of large multicenter studies were by-and-large very disappointing. This fiasco can be explained by several factors, but one of the most important reasons is the uncertain definition of sepsis resulting in very heterogeneous patient populations, and the lack of understanding of pathophysiology, which is mainly based on the imbalance in the host-immune response. However, this heroic research work has not been in vain. Putting the results of positive and negative studies into context, we can now approach sepsis in a different concept, which may lead us to new perspectives in diagnostics and treatment. While decision making based on conventional sepsis definitions can inevitably lead to false judgment due to the heterogeneity of patients, new concepts based on currently gained knowledge in immunology may help to tailor assessment and treatment of these patients to their actual needs. Early diagnosis of sepsis is crucial in treating septic patients and in these cases starting appropriate antibiotic therapy in time have a significant effect on survival. However, there is very little to help the clinician during the first 24 hours whether the administered empirical antibiotics treatment is effective or not. Procalcitonin is a reliable sepsis marker with short half life but its role in predicting bacterial infection and early decision making in assisting antibiotic therapy is undiscovered. Therefore we investigated the value of procalcitonin levels and changes from the day before (t-1) to the day when infection was suspected (t0), and after starting empirical antibiotic therapy 8 hourly (t8, t16, t24) then daily (day2-5) in predicting infection and if the antibiotic treatment is effective or ineffective inintensive care patients. Our results showed significant difference in procalcitonin kinetics in patients with and without bacterial infection and whom empiric antibiotic treatment is turned out afterwards to be effective or ineffective. There are three fundamental questions to be answered when treating patients with suspected or proven infections on the ICU: 1) is there infection, in other words should we start empirical antibiotic therapy; 2) is the commenced antibiotic effective; and finally 3) when should we stop antibiotic treatment? Our research team decided to give exact answers to these questions with the help of procalcitonin as it is a fundamental problem in our daily practice in the ICU.

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