Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients
Abstract Background Due to greater infection susceptibility, sepsis is the main cause of death in burn patients. Quick diagnosis and patient stratification, early and appropriated antimicrobial therapy, and focus control are crucial for patients’ survival. On the other hand, superfluous extension of...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Oxford University Press
2018-03-01
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| Series: | Burns & Trauma |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41038-018-0112-5 |
| _version_ | 1819054414840725504 |
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| author | Luís Cabral Vera Afreixo Rita Meireles Miguel Vaz Catarina Chaves Marisa Caetano Luís Almeida José Artur Paiva |
| author_facet | Luís Cabral Vera Afreixo Rita Meireles Miguel Vaz Catarina Chaves Marisa Caetano Luís Almeida José Artur Paiva |
| author_sort | Luís Cabral |
| collection | DOAJ |
| description | Abstract Background Due to greater infection susceptibility, sepsis is the main cause of death in burn patients. Quick diagnosis and patient stratification, early and appropriated antimicrobial therapy, and focus control are crucial for patients’ survival. On the other hand, superfluous extension of therapy is associated with adverse events and arousal of microbial resistance. The use of biomarkers, necessarily coupled with close clinical examination, may predict outcomes, stratifying patients who need more intensive care, and monitor the efficacy of antimicrobial therapy, allowing faster de-escalation or stop, reducing the development of resistance and possibly the financial burden, without increasing mortality. The aim of this work is to check the suitability of procalcitonin (PCT) to fulfill these goals in a large sample of septic burn patients. Methods One hundred and one patients, with 15% or more of total body surface area (TBSA) burned, admitted from January 2011 to December 2014 at Coimbra Burns Unit (CBU), in Portugal were included in the sample. All patients had a diagnosis of sepsis, according to the American Burn Association (ABA) criteria. The sample was factored by survival (68 survivors and 33 non-survivors). The maximum value of PCT in each day was used for statistical analysis. Data were summarized by location measures (mean, median, minimum, maximum, quartiles) and dispersion measures (standard error and range measures). Statistical analysis was performed with SPSS© 23.0 IBM© for Windows©. Results There were statistically significant differences between PCT levels of patients from the survivor and non-survivor groups during the first and the last weeks of hospitalization as well as during the first week after sepsis suspicion, being slightly higher during this period. During the first 7 days of antimicrobial therapy, PCT was always higher in the non-survivor, still without reaching statistical significance, but when the analysis was extended till the 15th day, PCT increased significantly, rapidly, and steadily, denouncing therapy failure. Conclusion Despite being not an ideal biomarker, PCT proved to have good prognostic power in septic burn patients, paralleling the evolution of the infectious process and reflecting the efficacy of antimicrobial therapy, and the inclusion of its serial dosing may be advised to reinforce antimicrobial stewardship programs at burn units; meanwhile, more accurate approaches are not available. |
| first_indexed | 2024-12-21T12:51:15Z |
| format | Article |
| id | doaj.art-3dbeb65db09d433c8a019b10293f93f9 |
| institution | Directory Open Access Journal |
| issn | 2321-3876 |
| language | English |
| last_indexed | 2024-12-21T12:51:15Z |
| publishDate | 2018-03-01 |
| publisher | Oxford University Press |
| record_format | Article |
| series | Burns & Trauma |
| spelling | doaj.art-3dbeb65db09d433c8a019b10293f93f92022-12-21T19:03:28ZengOxford University PressBurns & Trauma2321-38762018-03-016111010.1186/s41038-018-0112-5Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patientsLuís Cabral0Vera Afreixo1Rita Meireles2Miguel Vaz3Catarina Chaves4Marisa Caetano5Luís Almeida6José Artur Paiva7Department of Plastic Surgery and Burns Unit, Unidade de Queimados, Coimbra University Hospital Centre (CHUC)CIDMA - Center for Research and Development in Mathematics and Applications, iBiMED, Institute for Biomedicine, University of AveiroDepartment of Plastic Surgery and Burns Unit, Unidade de Queimados, Coimbra University Hospital Centre (CHUC)Department of Plastic Surgery and Burns Unit, Unidade de Queimados, Coimbra University Hospital Centre (CHUC)Clinical Pathology Department, Coimbra University Hospital Centre (CHUC)Pharmacy Department, Coimbra University Hospital Centre (CHUC)MedinUP, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of PortoDepartment of Emergency and Intensive Care Medicine, Centro Hospitalar São JoãoAbstract Background Due to greater infection susceptibility, sepsis is the main cause of death in burn patients. Quick diagnosis and patient stratification, early and appropriated antimicrobial therapy, and focus control are crucial for patients’ survival. On the other hand, superfluous extension of therapy is associated with adverse events and arousal of microbial resistance. The use of biomarkers, necessarily coupled with close clinical examination, may predict outcomes, stratifying patients who need more intensive care, and monitor the efficacy of antimicrobial therapy, allowing faster de-escalation or stop, reducing the development of resistance and possibly the financial burden, without increasing mortality. The aim of this work is to check the suitability of procalcitonin (PCT) to fulfill these goals in a large sample of septic burn patients. Methods One hundred and one patients, with 15% or more of total body surface area (TBSA) burned, admitted from January 2011 to December 2014 at Coimbra Burns Unit (CBU), in Portugal were included in the sample. All patients had a diagnosis of sepsis, according to the American Burn Association (ABA) criteria. The sample was factored by survival (68 survivors and 33 non-survivors). The maximum value of PCT in each day was used for statistical analysis. Data were summarized by location measures (mean, median, minimum, maximum, quartiles) and dispersion measures (standard error and range measures). Statistical analysis was performed with SPSS© 23.0 IBM© for Windows©. Results There were statistically significant differences between PCT levels of patients from the survivor and non-survivor groups during the first and the last weeks of hospitalization as well as during the first week after sepsis suspicion, being slightly higher during this period. During the first 7 days of antimicrobial therapy, PCT was always higher in the non-survivor, still without reaching statistical significance, but when the analysis was extended till the 15th day, PCT increased significantly, rapidly, and steadily, denouncing therapy failure. Conclusion Despite being not an ideal biomarker, PCT proved to have good prognostic power in septic burn patients, paralleling the evolution of the infectious process and reflecting the efficacy of antimicrobial therapy, and the inclusion of its serial dosing may be advised to reinforce antimicrobial stewardship programs at burn units; meanwhile, more accurate approaches are not available.http://link.springer.com/article/10.1186/s41038-018-0112-5BurnsSepsisProcalcitoninPrognosisAntimicrobial stewardship |
| spellingShingle | Luís Cabral Vera Afreixo Rita Meireles Miguel Vaz Catarina Chaves Marisa Caetano Luís Almeida José Artur Paiva Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients Burns & Trauma Burns Sepsis Procalcitonin Prognosis Antimicrobial stewardship |
| title | Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients |
| title_full | Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients |
| title_fullStr | Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients |
| title_full_unstemmed | Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients |
| title_short | Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients |
| title_sort | checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients |
| topic | Burns Sepsis Procalcitonin Prognosis Antimicrobial stewardship |
| url | http://link.springer.com/article/10.1186/s41038-018-0112-5 |
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