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  • Precalcitonin guided...

Precalcitonin guided Protocol Safely Reduces Antibiotic Use in Sepsis Patients, reveals study

Written By : Dr Riya Dave |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2024-12-13T08:45:51+05:30  |  Updated On 13 Dec 2024 2:24 PM IST
Precalcitonin guided Protocol Safely Reduces Antibiotic Use in Sepsis Patients, reveals study
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Researchers found that a procalcitonin (PCT)-guided protocol significantly reduces the duration of antibiotic therapy in critically ill patients with sepsis as published in JAMA. This study was conducted by Paul Dark and colleagues.

Sepsis is a medical condition in which life is endangered by a flood of immune reactions to infection and usually requires emergency antibiotics. Therefore, early and timely antibiotic intervention is essential; however, the duration of treatment is still not well defined. Biomarkers such as PCT and CRP have been evaluated for the possible use of guiding antibiotic discontinuation decisions. This trial provides additional support for PCT-use recommendations, establishing their clinical effectiveness and safety.

Methods

The Antibiotic Treatment in Hospitalised Patients With Suspected Sepsis (ADAPT-Sepsis) trial enrolled 2,760 suspected-sepsis adult patients in 41 hospitals across the United Kingdom from January 2018 to June 2024. It randomised ICU patients who had received intravenous antibiotics within 24 hours of admission into 3 groups: daily PCT-guided protocol (918 patients), daily CRP-guided protocol (924 patients), or standard care (918 patients). Primary endpoints included total antibiotic usage for 28 days and 28-day all-cause mortality. Secondary outcomes also include the duration of antibiotics first until the sepsis episode. Both allocation and biomarker readings were blinded to clinical teams and patients.

Key Findings

Reduction in the duration of antibiotics:

• PCT-guided protocol reduced total antibiotic duration to 9.8 days compared with that of the standard care arm at 13.2 days (adjusted mean difference, 3.4 days; 95% CI, 4.3-2.5).

• The CRP protocol was not statistically significantly shorter than standard care (mean difference: 0.09 days; 95% CI, -0.60 to 0.79).

• For early initial sepsis, PCT reduced antibiotic usage during this period by 1.13 days (95% CI, 0.58 to 1.68), while CRP indicated a 0.71-day decrement (95% CI, 0.16 to 1.26).

Safety Endpoints:

• Across all causes, mortality at 28 days was statistically equal for PCT-guided care versus standard care (20.9% vs. 19.4%; absolute difference: 1.57 percentage points; 95% CI, -2.18 to 5.32).

• Mortality outcomes with CRP-guided care were inconclusive (21.1% vs. 19.4%; absolute difference: 1.69 percentage points; 95% CI, -2.07 to 5.45).

This trial shows that protocols based on procalcitonin safely reduce antibiotic use in critically ill patients with sepsis and induce 10% reduction in duration. These observations provide decisive grounds for the incorporation of procalcitonin into sepsis management.

Reference:

Dark P, Hossain A, McAuley DF, et al. Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial. JAMA. Published online December 09, 2024. doi:10.1001/jama.2024.26458

JAMAProcalcitoninsepsisantibioticsbiomarkersantimicrobial resistancecritical care
Source : JAMA
Dr Riya Dave
Dr Riya Dave

    Dr Riya Dave has completed dentistry from Gujarat University in 2022. She is a dentist and accomplished medical and scientific writer known for her commitment to bridging the gap between clinical expertise and accessible healthcare information. She has been actively involved in writing blogs related to health and wellness.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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