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Volume 17 Supplement 4

Sepsis 2013

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Effect of semi-quantitative procalcitonin assay on the adequacy of empirical antibiotics and mortality in septic patients

  • 1,
  • 2,
  • 3 and
  • 4
Critical Care201317 (Suppl 4) :P15

https://doi.org/10.1186/cc12915

  • Published:

Keywords

  • Septic Patient
  • Procalcitonin
  • Great Probability
  • Hospital Emergency
  • Considerable Morbidity

Background

Sepsis is a serious clinical condition with a considerable morbidity and mortality. Procalcitonin (PCT) is a good biomarker for early diagnosis and infection monitoring. A semi-quantitative PCT assay can be performed at the bedside and has good diagnostic value [1, 2]. The present study aimed to investigate the effect of a semi-quantitative PCT test on the empirical antibiotic initiation time, the appropriateness of empirical antibiotics and mortality in septic patients.

Materials and methods

The study design was a randomized diagnostic trial, which was also a pragmatic trial. Septic patients more than 18 years old with and without signs of organ hypoperfusion or dysfunction who were admitted to Cipto Mangunkusomo Hospital emergency department in the internal medicine unit were eligible. Subjects were randomly assigned to either a semi-quantitative PCT-examined group (study group) or a control group. Semi-quantitative PCT test results will be informed to the physicians taking care of the patients. The primary outcome was 14-day mortality. Secondary outcomes were the time of initiation and appropriateness of empirical antibiotics. A Tropical Infection Consultant will assess the appropriateness of empirical antibiotics based on Pedoman Umum Penggunaan Antibiotik Departemen Kesehatan Republik Indonesia.

Results

Two hundred and five patients met the inclusion criteria. Ninety-five of 100 subjects from the study group and 102 of 105 subjects from the control group were included in the analysis (Figure 1). Both groups have equal baseline characteristics (Table 1). The mortality risk was lower in the study group (RR 0.53; 95% CI 0.36 to 0.77). The study group had greater probability to have a first dose of empirical antibiotic in less than 6 hours compared with the control group (RR 2.48; 95% CI 1.88 to 3.26). No effect was seen in appropriateness of empirical antibiotics between groups (RR 0.99; 95% CI 0.92 to 1.08) (Table 2).
Figure 1
Figure 1

Enrollment of patients and completion of the study.

Table 1

Baseline characteristics of the patients

Characteristic

Semi-quantitative PCT-examined group, n (%)

Control group, n(%)

Age

  

   >60 years

28 (29.5)

23 (22.5)

   ≤60 years

67 (70.5)

79 (77.5)

Mean age (years)

51.4 ± 15.7

48.6 ± 46.0

Sex

  

   Male

42 (44.2)

40 (39.2)

   Female

53 (55.8)

62 (60.8)

Sepsis severity

  

   Sepsis

57 (60.0)

54 (52.9)

   Severe sepsis and septic shock

38 (40.0)

48 (47.1)

Comorbidity

  

   Without comorbidities

20 (21.1)

20 (19.6)

   With comorbidities

75 (78.9)

82 (80.4)

Source of infection

  

   One source

82 (86.3)

86 (84.3)

   ≥2 sources

13 (13.7)

16 (15.7)

14-day mortality

26 (27.4)

53 (52.0)

Table 2

Effect of semi-quantitative procalcitonin assay on adequacy of empirical antibiotics and mortality in septic patients

Outcomes

Semi-quantitative PCT assay, n(%)

RR (95% CI)

P value

 

Examined

Not examined

  

Empirical antibiotic initiation time

   

   ≤6 hours

83 (87.4)

36 (35.3)

2.48 (1.88 to 3.26)

<0.001

   >6 hours

12 (12.6)

66 (64.7)

  

Appropriateness of empirical antibiotics

   

   Appropriate

88 (92.6)

95 (93.1)

0.99 (0.92 to 1.08)

0.890

   Inappropriate

7 (7.4)

7 (6.9)

  

14-day mortality

    

   Yes

26 (27.4)

53 (52.0)

0.53 (0.36 to 0.77)

<0.001

   No

69 (72.6)

49 (48.0)

  

Conclusions

Semi-quantitative PCT examination affects the empirical antibiotic initiation time and mortality in septic patients, but not the appropriateness of empirical antibiotics.

Authors’ Affiliations

(1)
Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
(2)
Division of Tropical Medicine and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
(3)
Division of Allergy and Clinical Imunology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
(4)
Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia

References

  1. Hatzistilianou M: Diagnostic and prognostic role of procalcitonin in infections. Sci World J 2010, 10: 1941-1946.View ArticleGoogle Scholar
  2. Oh JS, Kim SU, Oh YM, Choe SM, Choe GH, Choe SP, et al.: The usefulness of the semiquantitative procalcitonin test kit as a guideline for starting antibiotic administration. Am J Emerg Med 2009, 27: 859-863. 10.1016/j.ajem.2008.06.021View ArticlePubMedGoogle Scholar

Copyright

© Dharaniyadewi et al.; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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