Procalcitonin Reduces Long-Term Infection-associated Adverse Events in Sepsis

PROGRESS was a multicenter trial of 266 patients with sepsis with lower respiratory tract infections, acute pyelonephritis, or primary bloodstream infection. Researchers randomized them to receive either PCT-guided discontinuation of antimicrobials or standard of care. The major outcome assessed was the rate of infection-associated adverse events at Day 180, a composite of the incidence of any new infection by Clostridioides difficile or multidrug-resistant organisms, or any death attributed to baseline C. difficile or multidrug-resistant organism infection. They also examined the 28-day mortality, length of antibiotic therapy, and cost of hospitalization.

Key findings of the study were:

♦ On comparing PCT and standard-of-care arms, researchers found that the patients in the PCT had reduced

• Rate of infection-associated adverse events was 7.2% versus 15.3% (hazard ratio, 0.45),
• 28-day mortality 15.2% versus 28.2% (hazard ratio, 0.51) and
• 29-median length of the antibiotic therapy was 5 (range, 5–7) versus 10 (range, 7–15) days.

♦ They also noted that the cost of hospitalization was also reduced in the PCT arm.

The authors concluded, "The PCT-guidance approach was associated with lower infection-associated adverse events, lower 28-day mortality, shorter LOT, early hospital discharge, and decreased costs of hospitalization. These benefits may have a substantial impact on public health, particularly for countries with high antimicrobial consumption."

For further information:

https://www.atsjournals.org/doi/10.1164/rccm.202004-1201OC