Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized...

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Clinical Trials

Background:

• Sepsis management in critically ill adults often involves prolonged antibiotic therapy.
• Biomarkers like procalcitonin (PCT) and C-reactive protein (CRP) are used to guide antibiotic duration, but their effectiveness and safety require further evidence.

Purpose of the Study:

• To evaluate if C-reactive protein (CRP) or procalcitonin (PCT) guided protocols can safely reduce antibiotic therapy duration in critically ill patients with suspected sepsis.

Main Methods:

• A multicenter randomized clinical trial involving 2760 adults in UK intensive care units.
• Patients were assigned to daily PCT-guided, daily CRP-guided, or standard care protocols.
• Primary outcomes included total antibiotic duration and 28-day all-cause mortality.

Main Results:

• The PCT-guided protocol significantly reduced antibiotic duration compared to standard care (mean difference, 0.88 days; P=.01) and was noninferior for 28-day all-cause mortality.
• No significant difference in antibiotic duration was observed between the CRP-guided protocol and standard care (P=.79).
• All-cause mortality for the CRP-guided protocol was inconclusive compared to standard care.

Conclusions:

• Procalcitonin (PCT) monitoring provides a safe and effective strategy to reduce antibiotic duration in critically ill patients with suspected sepsis.
• C-reactive protein (CRP) monitoring, in this trial, did not demonstrate a similar benefit in reducing antibiotic duration or conclusively impacting mortality.
• These findings support the use of PCT as a biomarker to optimize antibiotic stewardship in intensive care settings.