Abstract
Sepsis is the main cause of death in burns. Early institution of antimicrobial therapy is crucial to optimize outcomes but superfluous therapy increases adverse events, microbial resistance, and costs. Blood cultures are the gold standard for diagnosis but can take 48 to 72 hours. Biomarkers are used to help sepsis diagnosis and distinction between Gram-negative and Gram-positive bacterial cause. The aim of this work is to evaluate procalcitonin (PCT) accuracy for this distinction in burn patients. Retrospective observational study of adult septic burn patients with ≥15% total burn surface area admitted from January 2011 to December 2014 at a Burn Unit in Portugal. A statistical analysis was done, evaluating the correlation between PCT levels on the day of the first positive blood culture and microbiological data for Gram-negative and Grand-positive bacteria. Patients with mixed bacterial and/or fungal blood cultures were excluded. Data were summarized by quartiles statistics. Blood cultures were positive in 189 patients: 75 (39.7%) showed growth for Gram-negative and 114 (60.3%) for Gram-positive bacteria. Patients with Gram-negative bacteria have significantly higher PCT levels. Receiver operating characteristic curve analysis showed accuracy for Gram-negative discrimination with area under the curve = 0.687. Most elevated levels were related to nonfermentative Gram-negative bacteria and by Klebsiella pneumoniae and other Enterobacteriaceae. PCT levels were significantly higher in burn patients with Gram-negative sepsis comparing to patients with Gram-positive sepsis and controls. The determination of PCT levels may help the choice of empirical antimicrobial therapy while microbiological culture results are not available, despite not fully ensuring the desirable degree of precision.
Highlights
An early and adequate antimicrobial therapy is the main step for the management of septic patients.[1]
The aim of this work is to size up PCT performance for the differential diagnosis between sepsis by Gram-negative and Gram-positive bacteria in a large sample of burn patients
On the day of the first identification of microbiological growth in blood cultures, PCT levels were significantly higher in patients with Gram-negative bacteria comparing to controls and patients with Gram-positive bacteria; the differences between controls and Gram-positive infected patients did not reach statistical significance (Table 2)
Summary
An early and adequate antimicrobial therapy is the main step for the management of septic patients.[1] differential diagnosis between sepsis and the systemic inflammatory response triggered by trauma is difficult, in burn patients where the usual clinical signs of sepsis are frequently present even in the absence of microbial infection.[2] For instance, burn injuries leading to upregulation of the hypothalamic thermal center, physiologic release of catecholamines and cytokines, shift of fluids and the consequent cardiovascular changes, can produce hyperthermia, tachycardia, hypotension, etc., that are transitory and do not reflect any microbial invasion but just a tentative of adjustment of human body systems to the changes in the homeostatic equilibrium
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