A simple blood test can tell doctors when it is safe to stop antibiotics in patients recovering from sepsis, a review has found.
The review included 21 studies involving more than 6,000 patients who underwent blood tests for procalcitonin, a biomarker that becomes elevated during bacterial infections. It has been published in the journal Anaesthesia.
The analysis was undertaken by the National Institute for Health and Care Research (NIHR) funded Applied Research Collaboration Greater Manchester (ARC-GM), the NIHR Manchester HealthTech Research Centre in Emergency and Acute Care and the NIHR Manchester Biomedical Research Centre (BRC), in collaboration with Northern Care Alliance NHS Foundation Trust and Manchester University NHS Foundation Trust.
It revealed that health professionals who used procalcitonin tests as part of their decision making were able to safely stop antibiotics about two days earlier than when they were not used, without increasing risk of death.
The review findings suggest that more, higher-quality studies are still needed to determine whether another test, known as C-reactive protein is safe to use when deciding about antibiotic use in these patients.
Important milestone
The results are an important milestone in the care of sepsis, a life-threatening condition where the body’s response to infection damages its own tissues, leading to organ failure and death.
Treatment for the condition, one of the leading causes of death worldwide, usually involves 7-10 days of antibiotics.
Reduction in antibiotic use could also provide significant cost savings to health systems and limit unwanted drug side-effects.
UK health authorities, such as the National Institute for Health and Care Excellence (NICE), have not recommended routine use of these blood tests in hospitals because earlier evidence was limited and lacked UK trial data.
However, the review addresses the gap in knowledge and includes recent clinical trial data from the UK ADAPT-Sepsis trial, also led by University of Manchester researchers.
Trial comparison
In their review, the researchers assessed randomised controlled trials which compared procalcitonin tests with standard care and C-reactive protein tests with standard care, where antibiotics are given according to international, national, or local clinical guidelines, without biomarker testing.
In patients with sepsis, the findings show that procalcitonin tests may help healthcare professionals stop antibiotics about two days earlier than standard care and may reduce the risk of death by 5%.
However, it is still unclear whether using procalcitonin tests prevents people from getting sick again or leads to longer hospital stays.
Study co-author, Professor Paul Dark, is professor of critical care medicine at Northern Care Alliance NHS Foundation Trust and Vice Dean for health and care partnerships at the University of Manchester.
He said: “Our findings show that using a procalcitonin test can help healthcare professionals safely stop antibiotics for people with sepsis more quickly. This is exciting because it supports safe care whilst reducing the risk of antibiotic-resistant infections in the future.
“This will be better for patients, who will experience more limited side effects, and better for health care systems by providing significant cost savings.”
He added: “Our recent cost effectiveness study that was part of the ADAPT-Sepsis trial also suggests that implementing daily procalcitonin measurement into routine NHS sepsis care would likely be cost effective.
“This approach supports the UK’s 10-Year Health Plan to tackle antibiotic resistance and could inform future NICE sepsis guidelines, paving the way for routine use of these blood tests in sepsis care.”
- Sonya Rafiq, Chunhu Shi, Shraboni Ghosal, Paul Dark, Tim Felton, Evangelos Kontopantelis, Jo Dumville: Clinical effectiveness of procalcitonin- or C-reactive protein-guided antibiotic discontinuation protocols for adult patients who are critically ill with sepsis: a rapid systematic review and meta-analysis.