Customized treatments for sepsis lower treatment time and reduce length of ICU stays

Using a blood test and a decision algorithm, rather than standard hospital protocols, to determine the appropriate length of antibiotic therapy in patients with severe sepsis or septic shock can reduce duration of treatments, shorten ICU stays, and lower hospital costs— all without adverse effects on patients, according to new research.

“We have shown that it is possible to customize antibiotic treatment duration in patients with septicemia based on a reliable and robust blood test,” says Jérôme Pugin, M.D., of the Intensive Care Unit at the University Hospital in Geneva, Switzerland.

The findings appear in the first issue for March of the American Journal of Respiratory and Clinical Care Medicine, published by the American Thoracic Society.

The researchers randomized 79 patients to receive a treatment course of antibiotics either according standard treatment protocols administered by the treating physicians, or according to the decision algorithm based on measured blood levels of procalcitonin (PCT), a marker for severe bacterial infection in patients with suspected sepsis. For patients randomized to the PCT-based treatment there were predetermined “stopping rules” based on circulating PCT levels at which point investigators encouraged treating physicians to discontinue antibiotic therapy, although the treating physician retained the ultimate decision-making power.

In the analysis that included all 79 patients, the median treatment time for the PCT group was 3.5 fewer days than that of the control group, although the difference was not significant. However, once the investigators controlled for early drop-outs, previously undiagnosed infections, and patients whose physicians declined to stop antibiotic treatment when the algorithm would have dictated it, they found that patients treated by the PCT algorithm had a significantly shorter treatment time at 6 days, than patients treated according to standard protocols, who averaged 12.5 days on antibiotics.