Two studies have emphasized that the relationship between the daily variations of PCT could affect sepsis management regarding the length of antibiotic therapy [13,14]. Little is known, however, about PCT behavior in septic patients according to the appropriateness Belinostat fda of the first-line antibiotic therapy. In addition, previously published studies are sparse and provide conflicting results regarding the prognosis value of PCT [15-21].We therefore conducted an observational study in our 15-bed medical intensive care unit (ICU) to assess to which extent an appropriate empirical antimicrobial therapy could hasten the PCT decrease within the first days of sepsis management.
Materials and methodsStudy populationEvery episode of bacteremia, community-acquired pneumonia and ventilator-associated pneumonia (VAP), as defined below, was prospectively recorded by one of the investigators (PEC) in our ICU throughout the study period, for an epidemiological survey. In addition, PCT dosage was usually performed daily in every patient with suspected sepsis as a reliable tool to improve diagnosis and antimicrobial management [13]. In accordance with French law, no informed consent was required since all measurements were part of routine management. Accordingly, our local Ethics Committee approved the study.Every patient with either bacteremia, community-acquired pneumonia or VAP, as defined below, on admission to or during the stay in the ICU was therefore eligible for the study if the PCT dosage had been obtained at the onset of clinical sepsis according to the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (that is, day 1 (D1)) and at least twice more within next 3 days.
No rule was applied regarding the availability of C-reactive protein dosages since our study focused on PCT. Only patients with proven bacterial infection as described below were kept for further analysis, provided they had not received any appropriate antibiotics during the 48 hours prior to the diagnosis of sepsis.
The following information was prospectively collected: the main clinical and epidemiological data at ICU admission, such as age, gender, type of admission (admission was considered surgical in patients who had undergone GSK-3 surgery within the 30 days preceding the onset of bloodstream infection, and medical otherwise), and severity of illness on admission expressed by the Simplified Acute Physiology Score (SAPS) II; patient characteristics at the onset of sepsis and then daily until D4, including main biological results, the septic condition (that is, sepsis, severe sepsis or septic shock), and organ dysfunction expressed by the Sepsis-related Organ Failure Assessment (SOFA) score; the infection source, if known; microbiological findings; and outcome in the ICU (that is, death or discharge).Other data were collected retrospectively.