Procalcitonin Reduces Long-Term Infection-associated Adverse Events in Sepsis
The U.S. CDC and the European Centre for Disease Prevention and Control have identified antimicrobial resistance as an alarming global public health threat. The use of a host-response marker procalcitonin (PCT), has received ample scientific attention recently as an adjunct to clinical judgment. A study published in the American Journal of Respiratory and Critical Care Medicine on April 18, 2020, suggests that in sepsis, PCT guidance was effective in reducing infection-associated adverse events, 28-day mortality, and cost of hospitalization.
The procalcitonin (PCT)-guided discontinuation of antibiotic therapy was demonstrated to reduce antibiotic exposure in patients with lower respiratory tract infections and/or sepsis in several randomized trials. However, the effect on the incidence of infections by resistant microorganisms has not been studied and the outcomes in long-term sepsis sequelae remain unclear. Therefore researchers of Athens, Greece, conducted a study, to investigate if PCT guidance may reduce the incidence of 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."
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