Better managing antibiotic use in sepsis patients

UK researchers are taking part in a £1.5 million study aiming to antibiotic resistance in sepsis patients — the largest ever trial to look at biomarkers in the blood to see whether antibiotics should be continued or can be safely stopped.

Sepsis occurs when the body’s response to an infection injures its own tissues and organs, leading to shock and multiple organ failure. An extremely serious condition, its symptoms can be similar to those of a simple viral infection. This means it isn’t easy to diagnose, with no recognised test as yet.

At present, patients with suspected sepsis are quickly treated with potent antibiotics, normally for at least seven to 10 days. But with antibiotic resistance a growing problem, the UK’s National Health Service (NHS) is striving to safely reduce their use where possible. With this in mind, the National Institute for Health Research (NIHR) is funding a study to determine whether one of two different tests will allow a safe reduction in the time patients in hospital with suspected sepsis are kept on antibiotics.

“Sepsis is a very dangerous condition and we have to react very quickly if it’s suspected — it is important to start treating patients as quickly as possible,” said Professor Paul Dark, NIHR national specialty lead in critical care, who is leading the research.

“But there isn’t good-quality evidence on which we can base a decision to stop giving antibiotics and that means that even when patients are getting better — and some may not have had sepsis at all — we are still giving antibiotics for at least 7–10 days.

“We want to be able to use antibiotics more effectively, making sure we have the safest possible care for patients. We are using a precision medicine approach by monitoring markers in the blood for each individual every day to guide when to stop their antibiotics.

“Our study will look at two different markers in the blood: C-reactive protein, which is often used in the NHS to monitor inflammatory conditions but not routinely for sepsis as yet, and procalcitonin, a newer test, used as a marker for severe bacterial infection.”

After a pilot phase, the study will recruit more than 2700 patients at 30 NHS hospitals across the UK. They will be assigned to one of three arms of the trial, with one group continuing to receive standard care, one group having C-reactive protein monitored each day and the final group having procalcitonin checked daily. The researchers will compare how long patients remain on antibiotics and the size of the dose, as well as survival rates and how long it takes for them to be well enough to be discharged from hospital.