Healthcare (Commonwealth Union) – A large UK trial suggests daily monitoring could cut unnecessary drug use in intensive care and help fight antibiotic resistance.
As remains a global concern that is responsible for many hospitalisations and deaths, the need to combat sepsis with another challenge, which is antimicrobial resistance remains a key concern.
The study was led by the University of Manchester and the Northern Care Alliance NHS Foundation Trust and mainly funded by the National Institute for Health and Care Research (NIHR). It involved 2,760 patients in 41 intensive care units across the country. The findings are published in the journal Anaesthesia.
A delicate balancing act
Sepsis is a life-threatening condition that occurs when the body overreacts to an infection. It is responsible for thousands of deaths every year. Patients with severe sepsis are typically given powerful antibiotics, and they often stay on them for long periods because doctors are understandably wary of stopping too soon in people who are so seriously ill.
But prolonged antibiotic use carries its own risks. Unnecessary treatment can drive antimicrobial resistance, where bacteria evolve to withstand the drugs designed to kill them. It can also cause side effects and add to healthcare costs.
The research team looked at whether blood tests could help doctors decide when treatment can safely end. The trial, known as ADAPT-Sepsis, examined how clinicians responded to automated advice generated from daily blood tests.
Two markers compared
Researchers compared two blood markers. One, called procalcitonin (PCT), is a protein that tends to rise in response to bacterial infection. The other, C-reactive protein (CRP), is a more commonly used general marker of inflammation.
The team found that guidance based on procalcitonin produced “stop antibiotics” recommendations nearly two days earlier than guidance based on CRP, a significant difference for patients in intensive care.
The picture was more complicated when it came to what doctors actually did. Clinicians were more likely to follow advice generated from CRP testing. The researchers suggest this is because CRP-based guidance more closely mirrors existing prescribing habits and tends to recommend continuing standard care. Even so, the earlier signals from procalcitonin testing offer greater potential to reduce the total amount of antibiotics patients receive.
More than 17,000 blood samples and pieces of treatment advice were analysed during the trial.
Why doctors held back
The study also explored why clinicians sometimes chose not to follow a recommendation to stop antibiotics. The most common reason was that existing microbiology guidance called for fixed treatment durations. Other factors included worries about ongoing severe illness, persistent fever and raised inflammation markers.
The findings add to evidence gathered through the wider ADAPT-Sepsis research programme. The researchers describe this latest analysis as the final piece of the puzzle in deciding whether the approach could be adopted across the NHS.
What the researchers say
Professor Paul Dark, the study’s principal researcher, indicated that intensive care doctors have long faced a near-impossible dilemma. Stopping antibiotics too early could put a patient’s life at risk, he explained, but continuing them without need also poses real dangers, both to individual patients and to wider society. Professor Dark is Vice Dean for health and care partnerships at the University of Manchester and Professor of critical care medicine at the Northern Care Alliance.
He said the study shows that simple biomarker tests can offer an extra layer of reassurance when clinicians are making these difficult calls. The next challenge, he added, is helping healthcare teams feel confident acting on that information, so that patients receive the right treatment for exactly as long as they need it.
Funding and further information
The trial was funded by the NIHR Applied Research Collaboration Greater Manchester, the NIHR Manchester HealthTech Research Centre in Emergency and Acute Care, and the NIHR Manchester Biomedical Research Centre. It was carried out in collaboration with the Northern Care Alliance NHS Foundation Trust and Manchester University NHS Foundation Trust.
