Introduction: Solid organ transplant patients with bacteremic sepsis are usually treated with antibiotics for 10-21 days. The evidence to support this length of therapy is lacking. The aim of the study was to evaluate if time-to-biomarker clearance was shorter than prescribed antibiotic duration by physicians blinded to results. We hypothesize that the sequential measurement of a host biomarker (procalcitonin [PCT]) and a microorganism biomarker (endotoxin activity assay [EAA]) could reduce antibiotic duration.
Methods: Twenty patients with proven bacteremic sepsis, on antibiotics for ≤ 48h were consented. PCT and EAA were measured every other day for 14 days, with treating clinicians and investigators blind to results. Mann-Whitney test and multivariable regression were performed.
Results: The baseline characteristics were: Allografts: liver (9), kidney (8), small-bowel (2), heart (1); Median age: 50 years (IQR 40-65); APACHE II score: 17.5 (IQR 15-31); Median baseline PCT=4.97 ng/ml (IQR 1.67-47.9) and EAA=0.49 EU/ml (IQR 0.42-0.60). Time-to- PCT clearance (5 days [4.0-9.5]; p<0.0001), time-to-EAA clearance (4 days [2.0-10]; p<0.0001), and time-to-both PCT/EAA clearance (6 days [4.0-11.5]; p<0.0001) were all significantly shorter compared to the total duration of antibiotic days (median 16 days [14-21]). Univariate regression showed that a higher baseline PCT (p=0.031), longer time-to-PCT clearance (p=0.004), longer time-to-EAA clearance (p=0.01) and delta EAA (days 4-0) (p=0.003) were all predictors of a more prolonged use of antibiotics. After adjusting for disease severity by APACHE II score, the regression model showed that time-to-PCT clearance (p=0.045), and delta EAA (days 4-0) (p=0.05) remained predictive of prolonged use of antibiotics.
Conclusion: Sequential monitoring of procalcitonin and endotoxin showed that both host and microorganism biomarkers were cleared at days 4-5 after treatment initiation, while antibiotics were continued for 11 more days. Biomarkers dynamics may be a useful adjunctive tool to reduce antibiotic duration and individually tailor therapy for solid organ transplant patients.
To cite this abstract in AMA style:Florescu D, VanSchooneveld T, Haynatzki G, Shafer L, Chambers H, Hill L, Kalil A. Bacteremic Sepsis in Transplantation: Can Antibiotic Duration Be Shortened by the Use of Sequential Procalcitonin and Endotoxin? A Prospective Cohort Study [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/bacteremic-sepsis-in-transplantation-can-antibiotic-duration-be-shortened-by-the-use-of-sequential-procalcitonin-and-endotoxin-a-prospective-cohort-study/. Accessed October 31, 2020.
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