Introduction:
Early detection of sepsis is one of the important aspects of today’s emergency care. The availability of antibiotics has improved the patient care, but early diagnosis and correct antibiotic selection is still a challenge. Procalcitonin is one of the latest sepsis bio-markers, which have shown to be useful in tracking the course of sepsis and antibiotic response.
The aim of this study is to determine the feasibility of using procalcitonin readings in early prediction, before the antibiogram results are available (first 48 hours), in patients with sepsis coming to emergency department.
Patients and Methods:
The study is a prospective randomized clinical trial conducted in Imam Hossein Medical Center emergency department, Tehran, Iran. All patients with clinical findings suggesting sepsis or systemic inflammatory response syndrome who give consent will enter the study. Patients with systemic inflammation of non bacterial origin, viral or parasitic infections, patients who receive corticosteroids on immunosuppressive drugs will be excluded. Also all patients with a history of immunodeficiency or central venous catheter will be excluded. The sampling continues until 150 patients are entered into the study.
A predesigned questionnaire will be used to document the patients’ clinical findings. Peripheral blood sample for culturing and antibiogram and procalcitonin measurement, as well as other routine laboratory tests will be taken. The procalcitonin levels will be checked before, six, and twenty four hours after the initiation of antibiotic therapy. The procalcitonin measurement will be done using immunoluminometric measuring (Brahms PCT, Diasorin, USA). We will not interfere with any aspects of treatment and antibiotic therapy.
Antibiotic change, if necessary, will be carried on based on patients’ clinical findings and ultimately based on antibiogram. The results of procalcitonin readings will be compared to blood culture, urine culture, CSF cultures and antibiogram results, clinical findings and patients’ outcome.
We will calculate the sensitivity and specificity of procalcitonin in predicting the antibiotic response compared to antibiogram as the gold standard.