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Can gram-negative-like biomarker values in Streptococcus pyogenes sepsis negatively influence right choice of initial

V Adámková, H Lahoda Brodská, V Adámková

    Epidemiologie, Mikrobiologie, Imunologie : Casopis Spolecnosti Pro Epidemiologii a Mikrobiologii Ceske Lekarske Spolecnosti J.E. Purkyne
    |October 22, 2020
    PubMed

    Insights

    Sepsis caused by Streptococcus pyogenes shows higher procalcitonin levels than gram-negative bacteria, impacting initial antibiotic choice. Re-evaluating procalcitonin

    Area of Science:

    • Clinical Medicine
    • Infectious Diseases
    • Biomarkers

    Background:

    • Biomarkers like procalcitonin (PCT) and C-reactive protein (CRP) are crucial for sepsis diagnosis and antibiotic stewardship.
    • Gram-negative bacterial sepsis typically presents with higher PCT than CRP, guiding initial antibiotic selection.
    • Certain pathogens, such as Streptococcus pyogenes, may not follow typical biomarker patterns, potentially leading to incorrect initial treatment.

    Purpose of the Study:

    • To analyze biomarker levels, initial antibiotic therapy, and treatment outcomes in patients with sepsis caused by S. pyogenes, Escherichia coli, and Staphylococcus aureus.
    • To compare PCT and neutrophil-to-lymphocyte ratio (NLR) in sepsis patients with different causative agents.
    • To investigate the impact of biomarker patterns on initial antibiotic selection and patient outcomes.

    Main Methods:

    • Retrospective analysis of sepsis patients.
    • Comparison of biomarker levels (PCT, NLR) using Kruskal-Wallis and Dunn post-hoc tests (p < 0.05).
    • Evaluation of initial antibiotic therapy appropriateness and treatment outcomes.

    Main Results:

    • S. pyogenes sepsis exhibited significantly higher PCT levels (12.51 ng/ml) compared to E. coli (4.30 ng/ml) and S. aureus (0.75 ng/ml) sepsis (p < 0.001).
    • Neutrophil-to-lymphocyte ratio showed similar trends to PCT.
    • Appropriate initial antibiotic therapy was significantly lower in S. pyogenes sepsis (11.29%) compared to E. coli (100%) and S. aureus (99.3%) sepsis.

    Conclusions:

    • Contrary to previous studies, this cohort observed the highest PCT levels in S. pyogenes sepsis, mimicking gram-negative infections.
    • Elevated PCT in S. pyogenes sepsis may mislead initial antibiotic selection, potentially contributing to higher mortality.
    • Re-evaluation of procalcitonin's role in sepsis diagnostics is recommended to improve patient survival and quality of life.
    Keywords:
    biomarkeryiniciální ATB terapieklindamycinpoměr neutrofilů/lymfocytůprokalcitoninsepse

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