Ron Daniels, a clinician based in Birmingham, Chair of the UK Sepsis Trust and Chief Executive of the Global Sepsis Alliance, talks about the life threatening condition sepsis, a time critical emergency and the most common single reason for patient admission to an intensive care unit that claims 37,000 lives in the UK every year.
Sepsis arises as a result of the body’s response to infection, and can be triggered by anything from pneumonia to a cut or graze that becomes infected. When the body responds to this, sepsis cascade is the result causing inflammation throughout the body, and if unchecked, sepsis will lead to multiple organ failure, shock and death. Early appropriate antibiotics and intravenous fluids delivered to patients as quickly as possible will save lives.
Dr Kordo Saeed, Consultant Microbiologist with the Winchester and Eastleigh NHS Trust, talks about a six-month trial evaluating the serum procalcitonin concentration (PCT) measurement, as a diagnostic tool to support clinical decision making to either administer or withhold antibiotics in situations where there is a suspicion of bacterial infection, but the diagnosis is uncertain.
During the six-month trial, 99 patients on a medical admission unit (MAU) with suspected infection, and 42 patients on an intensive care unit (ICU) with clinical signs or physiological parameters suggesting possible new infection, had serum PCT concentration measured, with the results available within 90 minutes of the request. The test was initiated by the microbiology/infection team during clinical consultations to support the antibiotic decision. On the basis of low PCT values, antibiotics were withheld, in MAU on 52 occasions and in ICU on 42 occasions.
Patients were monitored over a week. There was neither progression of bacterial infection requiring antibiotics, or complications, or infection-related mortality in any patients who were denied antibiotics. Without the PCT value it is likely that all of these patients would have received empirical antibiotics.