CONTINUING EDUCATION :: SEPSIS
Procalcitonin serial testing to inform treatment of sepsis
By Chris Ann Dague, BSMT S
epsis, also known as blood poisoning or septicemia, is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.1
Sepsis continues
to be the leading cause of death in U.S. hospitals, representing around 25 percent of patients.2-3
According to the CDC, of the
1.7 million American adults that develop sepsis, 270,000 die each year.4
The primary infections that lead to sepsis are respiratory (35 percent), genitourinary (25 percent), gastrointestinal (11 percent), and infections of the skin (11 percent).2,4
The average
With an annual cost of hospital care for sepsis patients estimated at around $24 billion in the U.S., the con- dition places a significant burden on the healthcare system.5 However, with rapid diagnosis and treatment, as many as 80 percent of sepsis deaths could be prevented.3
length of hospital stay for patients with sepsis is considerable, at around 9 days.4
LUMIPULSE G1200 fully automated immunoassay instrument; image courtesy of Fujirebio.
Antimicrobial resistance contributes to sepsis mortality rates Effective treatment for sepsis requires timely administration of a suitable antibiotic to prevent a rapid, often fatal deterioration in a patient’s clinical condition. However, the emergence of antimicrobial resistance (AMR) renders many antibiotics inef- fective. Fueled by poor antibiotic stewardship—administering antibiotics unnecessarily or prescribing the wrong antibiotic at the wrong dose, and for the wrong duration—AMR has considerable potential to impact sepsis mortality rates.6 CDC estimates that 20-50 percent of acute-care hospital antibiotic prescriptions and 30 percent of outpatient antibiotic prescriptions in the U.S. are unnecessary, mostly caused when antibiotics are inappropriately prescribed for viral infections. Furthermore, it is approximated that more than 70 percent of the bacteria responsible for the two million infections acquired in U.S. hospitals each year are resistant to at least one com- monly used antibiotic.7
Unless effective measures are put in
place to limit the development of AMR, these numbers are likely to rise.
Associated risks of antibiotic overuse include increases in disease severity, disease length, health complications, re- hospitalization, and the need for medical treatment of health
Earning CEUs
See test on page 12 or online at
www.mlo-online.com under the CE Tests tab. LEARNING OBJECTIVES
Upon completion of this article, the reader will be able to:
1. Discuss the burden that sepsis places on the U.S. healthcare system.
2. Describe the past biomarkers used for sepsis determination and their limitations.
3. Discuss how procalcitonin (PCT) represents a superior biomarker for sepsis.
4. Recall the importance of PCT serial testing and how it applies to antibiotic stewardship programs.
8 MARCH 2019
MLO-ONLINE.COM
problems that may be resolved on their own. These factors can have a considerable impact on patient quality of life and contribute significantly to added healthcare costs.7
To improve
patient outcomes and antibiotic effectiveness, diagnostic and prognostic testing to aid antibiotic therapy decision-making has an essential role.
Antibiotic misuse contributes to Clostridium difficile infection
The incidence and severity of Clostridium difficile infection (CDI) has increased dramatically within the past two decades, making the Clostridium difficile bacterium the most common cause of nosocomial infections in developed countries. Respon- sible for almost half a million infections in the U.S. each year, CDI is associated with significant morbidity and mortality.8 Patients at increased risk of CDI include those receiving antibiotic therapy or patients who are immunocompromised through chemotherapy treatment or HIV infection.9
Due to
In a meta-analysis, the average CDI-attributable cost per case was $20,085 for community-acquired CDI and $34,149 for hospital-acquired CDI. These figures were associated with an average length of stay of 5.7 days for community-acquired CDI and 7.8 days for hospital-acquired CDI.11 An average 20.9 percent recurrence rate has been reported for healthcare-associated CDI, resulting in an estimated 61,400 first recurrent infections.10
Given the challenges of
treating recurrences, and because almost all antibiotics are associated with an increased risk of CDI, initiatives aimed to reduce CDI incidence should target reduced antimicrobial exposure through effective antibiotic stewardship programs.12
Current methods to identify systemic bacterial infections require improvement
Signs of bacterial and viral infections frequently overlap, including elevated body temperature, heart rate, respiratory
resultant diarrhea and the development of potentially life- threatening complications such as sepsis, CDI represents a substantial clinical burden. It has been estimated that excess healthcare costs related to CDI could be as much as $4.8 billion for acute-care facili- ties alone.10
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