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Optimization of antibacterial treatment in pediatric intensive care units using procalcitonin
Critical Care volume 11, Article number: P44 (2007)
Neonates and infants in the ICU are at high risk of severe infections and sepsis. Often it is not easy to diagnose sepsis based only on clinical findings; reliable biomarkers are needed to prove the diagnosis.
To study the value of procalcitonin (PCT) as a marker, verifying the diagnosis, which enables the start of de-escalating ABT in patients with clinical signs of sepsis.
Three hundred and seventy-four patients on artificial lung ventilation from two pediatric ICUs of two Russian hospitals were enrolled. Blood samples for PCT testing (PCT LIA; BRAHMS AG, Germany) were taken under suspicion of sepsis or exacerbation of bacterial infection. In the first stage (January–December 2005), 50 neonates (age 6 (4–12) days) with various perinatal pathologies were studied (Group A), and routine ABT was prescribed, with blood samples taken and stored for further PCT assessment. In the second stage (January–November 2006), 324 infants (age 6 (1.5–9.4) months) after cardiac surgery were enrolled (Group B), and ABT was adjusted based on PCT-testing results. PCT > 2 ng/ml indicative of systemic bacterial inflammation in addition to clinical signs of sepsis was an indication for ABT with carbapenems. Data are shown as the median and interquartile range.
Sepsis was diagnosed in 16/50 (32%) patients. PCT > 2 ng/ml was observed in 23/50 (46%) cases, including 15/16 (94%) patients with clinically diagnosed sepsis. In patients with PCT > 2 ng/ml the mortality rate was 7.7% if carbapenems (meropenem or imipenem/cilastatin) were administered (n = 13), compared with 20% with different ABT (n = 10) – although in patients with PCT < 2 ng/ml (n = 27), ABT with carbapenems (n = 12) resulted in paradoxically higher mortality compared with other ABT schemes (n = 15): 17% vs 6.6%.
Sepsis was defined in 24/324 (7.4%) patients. PCT > 2 ng/ml was in 53/324 (16%) cases, including all patients with clinically diagnosed sepsis. Early ABT with meropenem, combined with vancomycin or linezolid, allowed one to decrease sepsis-related mortality in these patients to 29%, which used to be as high as 74% before the introduction of this algorithm (P = 0.0028).
Early verification of sepsis using PCT combined with carbapenems-based ABT enables decreasing sepsis-related mortality in critically ill infants and newborns staying in the ICU.
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Beloborodova, N., Popov, D., Traube, M. et al. Optimization of antibacterial treatment in pediatric intensive care units using procalcitonin. Crit Care 11, P44 (2007). https://doi.org/10.1186/cc5204
- Pediatric Intensive Care Unit