CRP Versus PCT as Bio-markers for Sepsis and in Guiding Antibiotics in Critically Ill Patients
Condition: Sepsis; Morality
MeSH terms: Sepsis
Study type: Observational

Summary: 
      Sepsis is a life threatening organ dysfunction caused by infection. Severe sepsis is expected
      to rise due to resistance to antibiotics. Inappropriate use of antibiotics in the ICU leads
      to adverse drug reaction and bacterial resistance. Using biomarkers for infection as PCT and
      CRP are useful in diagnosing infection and duration of therapy. CRP based protocol will be
      compared to PCT based protocol for reducing the length of stay and reduction of antibiotic
      use in critically ill patients.
    

Detailed description: 
      Sepsis is a syndrome of physiologic, pathologic, and biochemical abnormalities induced by
      infection. It is defined as life-threatening organ dysfunction caused by a dysregulated host
      response to infection. It is a major public health concern, accounting for more than $20
      billion (5.2%) of total US hospital costs in 2011. Not only is sepsis expensive and
      prevalent, but it is a major cause of mortality and critical illness worldwide. Moreover,
      cases of severe sepsis are expected to rise in the future for several reasons, including:
      Increased awareness and sensitivity for the diagnosis; increasing numbers of
      immunocompromised patients; wider use of invasive procedures; more resistant microorganisms;
      and old aging population.

      Use of appropriate antibiotics in the intensive care unit (ICU) is a major challenge. Studies
      have shown that up to 50% of antibiotics prescribed in hospital settings are either
      unnecessary or inappropriate, contributing to increasing rates of resistant organisms,
      increases in adverse drug reactions, overall length of stay (LOS) and mortality. In addition,
      in critically ill patients, a long duration of treatment with antibiotics is associated with
      the development of antimicrobial resistance. Moreover, Sepsis and Systemic Inflammatory
      Response Syndrome (SIRS) SIRS can closely mimic one another and present a diagnostic
      challenge. So, determination of the presence or absence of bacterial infection is important
      to guide appropriate therapy and reduce antibiotic exposure. For microorganism detection,
      culture sensitivity is used though it has some drawbacks as time consuming, sometimes
      misleading with negative or positive reports and also they don't give information about the
      onset of organ dysfunction. Accordingly, it is important to differentiate culture negative
      sepsis patients from those with noninfectious SIRS, as these disease conditions require
      different therapeutic regimens. Due to these drawbacks of culture, researchers tried to
      depend on other more specific blood markers.

      Biomarkers of infection, namely C-reactive protein and procalcitonin (PCT) have been shown to
      be useful in the diagnosis of infection as well as in the assessment of its response to
      antibiotic therapy. C-reactive protein variations overtime appears to have a good performance
      for the diagnosis of infection. Procalcitonin shows a better correlation with clinical
      severity.

      Despite being used routinely in several intensive care services as an auxiliary criterion for
      decisions regarding antibiotic therapy, no C- reactive protein based protocol has been tested
      in clinical trials to guide the reduction of antibiotic use in patients with sepsis until
      2012. In 2013 Oliveira et al. compared a protocol based on serum PCT levels versus a protocol
      based on serum C-reactive protein levels for reducing the duration of antibiotic treatment in
      critically ill patients presenting with severe sepsis or septic shock. The latter study
      showed that C-reactive protein was as useful as procalcitonin in reducing antibiotic use in a
      predominantly medical population of septic patients, causing no apparent harm.
    

Intervention name(s): Procalcitonin biomarker and CRP biomarker
Intervention type(s): Diagnostic Test
Intervention description(s): collecting blood samples to measure serum CRP and Procalcitonin
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        patients with sepsis or septic shock