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Reassessing Procalcitonin-Guided Antibiotic Therapy in Critically Ill Patients with Sepsis: Lessons from the ADAPT-Sepsis Trial

  • 0Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America +

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June 27, 2025

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June 27, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

Procalcitonin (PCT) guided sepsis care reduced antibiotic duration but not mortality in critically ill patients. C-reactive protein (CRP) showed no benefit, highlighting the need for improved biomarker implementation strategies.

Area Of Science

  • Critical Care Medicine
  • Infectious Diseases
  • Biomarker Research

Background

  • Randomized trials suggest procalcitonin (PCT) guided algorithms can reduce antibiotic duration in sepsis.
  • However, trial design limitations and unclear stewardship practices have hindered confidence in PCT's benefits.
  • The ADAPT-Sepsis trial aimed to address these gaps with a concealed intervention and robust stewardship.

Purpose Of The Study

  • To compare procalcitonin (PCT) guided algorithms versus C-reactive protein (CRP) guided algorithms for antibiotic discontinuation in critically ill sepsis patients.
  • To evaluate the impact of PCT and CRP guidance on antibiotic use and patient mortality.
  • To assess algorithm adherence and stewardship practices in a real-world sepsis management setting.

Main Methods

  • Concealed intervention randomized controlled trial (ADAPT-Sepsis trial).
  • Head-to-head comparison of procalcitonin (PCT) and C-reactive protein (CRP) guided algorithms for antibiotic discontinuation.
  • Inclusion of critically ill patients with sepsis and robust stewardship protocols.

Main Results

  • Procalcitonin (PCT) guided care significantly reduced antibiotic use compared to standard care.
  • C-reactive protein (CRP) guided care demonstrated no significant benefit in reducing antibiotic use or improving outcomes.
  • No significant difference in mortality was observed between PCT-guided care and the control group.
  • Suboptimal algorithm adherence and a modest one-day reduction in antibiotic duration were noted with PCT guidance.

Conclusions

  • Procalcitonin (PCT) guided sepsis management can reduce antibiotic exposure but may not significantly impact mortality in critically ill patients.
  • C-reactive protein (CRP) is not a reliable biomarker for guiding antibiotic discontinuation in this population.
  • Future strategies should focus on integrating PCT and other biomarkers into multifaceted stewardship programs and addressing implementation barriers to enhance clinician trust and optimize patient outcomes.
  • Exploring earlier biomarker application in the sepsis care pathway, such as in Emergency Departments, warrants further investigation.

Keywords:

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