Increase in Procalcitonin Kinetics May be a Good Indicator of Starting Empirical Antibiotic Treatment in Critically Ill Patients

Study Overview
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Brief Summary
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The value of procalcitonin change from the day before to the day when infection was suspected in predicting bacterial infection in intensive care patients.

Detailed Description
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Starting antibiotic therapy early in critically ill patients with suspected infection is of utmost importance with significant effect on survival. Procalcitonin is a reliable sepsis marker but results about its usefulness in initiating antimicrobials are conflicting. Our aim is to investigate the predictive value of 24 hours procalcitonin kinetics before starting empirical antibiotic therapy in intensive care patients as an indicator of the presence of bacterial infection.

Conditions
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Bacterial Infection

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical signs of infection Suspected or proven acute infection requiring empiric antibiotic therapy as decided by the attending ICU physician Microbiological sample sent for staining Inflammatory markers available from the previous day Exclusion Criteria: Patients younger than 18 years Who received prophylactic or empiric antibiotic therapy 48 hours before inclusion Whose receiving acute renal replacement therapy in the first 24 hours following antibiotic treatment Following cardiopulmonary resuscitation End stage diseases with a do not resuscitate order Immunocompromised patients (human immunodeficiency virus infection, bone marrow transplantation, malignant haematological disorders and chemotherapy) Post cardiac surgery patients

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Infection<br>Based on the microbiological results and clinical picture patients were grouped post hoc into infection and no infection groups by two independent experts (intensivist, infectologist) who were blinded for procalcitonin. | |
| No infection<br>Based on the microbiological results and clinical picture patients were grouped post hoc into infection and no infection groups by two independent experts (intensivist, infectologist) who were blinded for procalcitonin. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Procalcitonin kinetic | Procalcitonin levels are measured at starting empiric antibiotic treatment and 24 hours before. The changes in percentage are calculated form the day before and right before the first exposition of the antibiotic therapy. | 24 hours before starting empiric antibiotic treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| C-reactive protein kinetic | C-reactive protein levels are measured at starting empiric antibiotic treatment and 24 hours before. The changes in percentage are calculated form the day before and right before the first exposition of the antibiotic therapy. | 24 hours before starting empiric antibiotic treatment | 
| Body temperature kinetic | Body temperatures are measured at starting empiric antibiotic treatment and 24 hours before. The changes in percentage are calculated form the day before and right before the first exposition of the antibiotic therapy. | 24 hours before starting empiric antibiotic treatment | 
| White blood cell count kinetic | White blood cell count levels are measured at starting empiric antibiotic treatment and 24 hours before. The changes in percentage are calculated form the day before and right before the first exposition of the antibiotic therapy. | 24 hours before starting empiric antibiotic treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Bacterial infection, empiric antibiotic therapy