 |
|
Customized treatments for sepsis lower treatment time and reduce length of ICU stays
February 29, 2008Using 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.
"Our study is the first randomized clinical trial in which a surrogate biochemical parameter was used to reduce the duration of antibiotic therapy in a population of critically ill patients admitted to the ICU for severe sepsis and septic shock," wrote Dr. Pugin. "Despite the relatively short duration of treatment in bacteremic patients assigned to the PCT group, no case of recurrence of infection was observed in these patients."
Following the PCT algorithm had another benefit: patients randomized to the PCT treatment had significantly shorter stays in the ICU than control patients-an average of three days versus five.
Customizing treatment does more than simply save hospitals money and patients precious days in the ICU, says Dr. Pugin. Overuse of antibiotics can result in antibiotic resistance. "Given the diversity of the types of infections, bacterial strains and levels of host immune defense, every infected patient should benefit from a personalized treatment, and particularly, a personalized treatment duration," he said.
The investigators hope that customized treatments will continue to improve care for sepsis patients around the world. "We have now implemented this new algorithm based on procalcitonin guidance in our ICU for patients presenting with severe sepsis and septic shock, and are following the outcome of those patients," said Dr. Pugin. "Currently, three large multi-center trials are ongoing in France, Denmark and Germany, with a design similar to that of our study. Results from these studies will be important to determine whether such a protocol of procalcitonin guidance is definitely safe and can be generalized worldwide."
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.
"Our study is the first randomized clinical trial in which a surrogate biochemical parameter was used to reduce the duration of antibiotic therapy in a population of critically ill patients admitted to the ICU for severe sepsis and septic shock," wrote Dr. Pugin. "Despite the relatively short duration of treatment in bacteremic patients assigned to the PCT group, no case of recurrence of infection was observed in these patients."
Following the PCT algorithm had another benefit: patients randomized to the PCT treatment had significantly shorter stays in the ICU than control patients-an average of three days versus five.
Customizing treatment does more than simply save hospitals money and patients precious days in the ICU, says Dr. Pugin. Overuse of antibiotics can result in antibiotic resistance. "Given the diversity of the types of infections, bacterial strains and levels of host immune defense, every infected patient should benefit from a personalized treatment, and particularly, a personalized treatment duration," he said.
The investigators hope that customized treatments will continue to improve care for sepsis patients around the world. "We have now implemented this new algorithm based on procalcitonin guidance in our ICU for patients presenting with severe sepsis and septic shock, and are following the outcome of those patients," said Dr. Pugin. "Currently, three large multi-center trials are ongoing in France, Denmark and Germany, with a design similar to that of our study. Results from these studies will be important to determine whether such a protocol of procalcitonin guidance is definitely safe and can be generalized worldwide."
American Thoracic Society
Sepsis Current Events and Sepsis News RSSWhat is the role of interleukin-10 in ischemia-reperfusion injury?
I/R injury of the small intestine is consequently a critical problem that is important. DHP-PMX therapy can remove circulating endotoxins and reduce various cytokines, even in patients with high levels of plasma cytokines.
Strategies for preventing gastrointestinal complications in severely burned patients
Gastrointestinal dysfunction is a common complication of severe burns. Injury to GI function, especially to GI barrier function, is an important initiator as well as a stimulator for occurrence of systemic inflammatory response syndrome, sepsis and multiple organ dysfunction syndrome following severe burns.
Scientists figure out how the immune system and brain communicate to control disease
In a major step in understanding how the nervous system and the immune system interact, scientists at The Feinstein Institute for Medical Research have identified a new anatomical path through which the brain and the spleen communicate.
Once suspect protein found to promote DNA repair, prevent cancer
An abundant chromosomal protein that binds to damaged DNA prevents cancer development by enhancing DNA repair, researchers at The University of Texas M. D. Anderson Cancer Center report online this week in the Proceedings of the National Academies of Science.
Pitt Team Receives $2.5 Million to Simulate and Analyze Brain, Immune System Activity and Apply Math to Medical Problems
In an effort to promote the application of mathematics to medical treatment, researchers in the University of Pittsburgh's Department of Mathematics will undertake a $2.5 million project to create models of how the brain and immune system function and change over time in response to certain illnesses, infections, and treatment.
Major 'missed' biochemical pathway emerges as important in virtually all cells
A new study by Duke University researchers provides more evidence that the nitric oxide (NO) system in the life of a cell plays a key role in disease, and the findings point to ways to improve treatment of illnesses such as heart disease and cancer.
CAPHOSOL relieves oral mucositis and improves quality-of-life in cancer patients
New data show that CAPHOSOL® (www.caphosol.com), an advanced electrolyte solution, relieves painful oral mucositis (OM) and improves quality of life for cancer patients undergoing chemotherapy and radiation therapy.
Ashwell receptor reduces mortality during sepsis
In research that solves the longest-standing mystery in glycobiology - a field that studies complex sugar chains called glycans - researchers at the University of California, San Diego School of Medicine have discovered that a molecule in the liver of all animals, called the Ashwell receptor, is critical in helping the body fight off the abnormal and lethal blood clotting caused by bacterial infection.
New discovery on role of vital protein that fights meningitis
A University of Leicester researcher has discovered how a protein in the blood - linked to defence against meningitis - plays a more vital role than previously understood in the body's immune defence system.
Researchers find possible target to treat deadly bloodstream infections
Researchers at the University of Illinois at Chicago have discovered a possible target to treat bloodstream bacterial infections.
More Sepsis Current Events and Sepsis News Articles
 | Sepsis Sepsis (or septic shock) is one of the leading post-surgical or post-traumatic complications in today's hospitals. This pervasive condition is the major cause of morbidity and mortality in intensive care units worldwide, as well as the leading cause of death in non-coronary patients. This is a concise, practical soft cover volume devoted to covering only the most practical information for... |
 | EMRA Sepsis Card Everything you need to know about improving outcomes for septic patients in the emergency department is now available in a handy pocket reference guide. This comprehensive yet compact review of the most recent recommendations for treating sepsis was developed by the EMRA Critical Care Committee and is endorsed by the Surviving Sepsis Campaign. New EMRA Resident Members recieve a complimentary... |
 | Contemporary Diagnosis and Management of Sepsis by E. Wesley Ely, Gordon R. Bernard This valuable reference provides clinicians with the most up-to-date data on accurate diagnostic techniques and management of this life-threatening illness, including the latest treatment... |
 | Sepsis: New Strategies for Management Sepsis is an important public health problem around the world. Severe sepsis carries significant morbidity, mortality and high costs. The incidence of sepsis is increasing because of the aging population, the growing number of immunocompromised hosts, the increasing use of invasive procedures, and, to a lesser extent, antibiotic resistance among pathogens. Despite recent advances in the... |
 | Sepsis and Multiorgan Failure State Univ. of New York, Stony Brook. Synthesis of the basic science and clinical concepts of treating sepsis and multiorgan failure. For practitioners, basic scientists, and epidemiologists. 100 contributors, 73 U.S. DNLM:... |
 | Sepsis: New Insights, New Therapies, Novartis Foundation Symposium (Novartis Foundation Symposia) by Novartis Foundation Sepsis: New Insights, New Therapies brings together contributions from an international group of experts in diverse fields to consider how the various pathways implicated in early and late sepsis interact, with a particular emphasis on novel concepts and potential new therapeutic approaches. Topics covered include adaptive immunity, inflammation, neuroendocrinology, bioenergetics and... |
| Sepsis Handbook | |
| Clinical Trials For The Treatmtnt Of Sepsis (Update in Intensive Care & Emergency Medicine) by W., ED. SIBBALD | |
 | Sepsis (Competency-Based Critical Care) Sepsis is a serious medical condition, resulting from the immune response to a severe infection. Septicaemia is sepsis of the bloodstream caused by bactemeria, which is the presence of bacteria in the bloodstream. The term septecaemia is also used to refer to sepsis in general. In the US, sepsis is the leading cause of death in non-coronary ICU patients, and the tenth most common form of death... |
 | Sepsis und MODS Für die erfolgreiche Behandlung der Sepsis und des MODS ist die optimale Therapiestrategie entscheidend! Komplett fachlich und didaktisch überarbeitet erscheint die 4. Auflage unter dem Motto: wissenschaftlich fundiert und in der Praxis bewährt: Klinische Grundlagen zur Definition, Möglichkeiten der Diagnostik, Systematik der Therapie und Prognose von Sepsis und MODS Antiinfektiöse... |
| © 2008 BrightSurf.com |