Utility of Serum Procalcitonin as a Biomarker to Determine the Duration of Antibiotic Therapy in Adult Patients with Sepsis and Septic Shock in Intensive Care Units

Background: Procalcitonin, a biomarker to adjudge the duration of antibiotic therapy in patients with sepsis. The degree of induction of Procalcitonin is associated with the severity of systemic infection and the presence of organ dysfunction. Thus, PCT is regarded as a useful biomarker for the diagnosis of sepsis, and recent studies have suggested that dynamic changes of PCT could be predictive of certain outcomes in patients with severe sepsis and septic shock.

Materials and Methods: In a mixed adult intensive care unit, a prospective, randomised, controlled, interventional study was conducted (ICU). In a nonblinded study, 90 adult patients were admitted to the ICU with sepsis and septic shock were randomly assigned to group P (group procalcitonin) and group C(group control). The duration of antibiotic therapy for patients in group P was determined based on serum procalcitonin levels versus standard treatment protocols in group C. A procalcitonin value of 0.01 ng/mL or a subsequent decline of more than 80% from the baseline was chosen as the cutoff for discontinuing antibiotic therapy. The primary goal was to compare the duration of antibiotic therapy in the two groups (in days). The secondary goal was to compare and evaluate the length of ICU stay, reinfection, secondary infection rate, readmission rate, and mortality rates among groups.

Results: The average duration of antibiotic therapy was significantly shorter in patients in the group of. P (4.98 ± 2.56 vs 7.73 ± 3.06 days, p < 0.001). Patients in group C spent more days in ICU (8.80 ± 3.35 vs 5.98 ± 2.73 days, p < 0.001). The secondary infection rate was significantly higher in group C (26.7% vs 4.4%, p = 0.014). The rates of readmission and mortality were comparable across groups.

Conclusion: In critically ill patients with sepsis, a serum procalcitonin-based algorithm could lead to a reduction in antibiotic therapy, ICU stay, and associated morbidities such as secondary infection rates. It also promotes antibiotic stewardship without having any negative effects on the patient's outcome. Thus, generalizing the findings to a population that would contain all the above-mentioned patients is not possible. Further multicenter trials enrolling larger populations are needed to validate the results of our study.