Can gram-negative-like biomarker values in Streptococcus pyogenes sepsis negatively influence right choice of initial antibiotic therapy?
Abstract
introduction: Biomarkers of sepsis are used to facilitate the diagnosis of sepsis and antibiotic stewardship. Gram-negative sepsis has been reported to have a distinct pattern of markedly increased procalcitonin vs.
C-reactive protein compared to patients with Gram-positive sepsis. However, selected infective agents may not follow this pattern, possibly leading to inappropriate choice of ATB therapy, (namely in Streptococcus pyogenes infection). methods: We retrospectively evaluated charts of septic patients infected by S. pyogenes, Escherichia coli or with Staphylococcus aureus sepsis, their biomarker pattern, appropriateness of the initial ATB therapy, a nd outcome.
Biomarker values were compared using Kruskal-Wallis test followed by Dunn Post-Hoc tests and as a threshold was used p < 0.05. results: Procalcitonin levels were higher in S. pyogenes sepsis (12.51 ng/ml, IQR: 6.26-48.38 ng/ml) vs E. coli sepsis (4.30 ng/ml, IQR: 1.50-10.00 ng/ml, p < 0.001) and vs S. aureus sepsis (0.75 ng/ml, QR: 0.34-1.62 ng/ml, p < 0.001). Neutrophil to lymphocyte ratio followed the same pattern as prokalcitonin.
Initial appropriate ATB therapy in S. pyogenes cohort was 11.29% compared to 99.3% and 100% in S. aureus and E. coli group, respectively. conclusion: Contrasting previous reports, the highest procalcitonin values were observed in the S. pyogenes group rather than in gram-negative sepsis. This has contributed to an inappropriate initial ATB therapy and, we believed, resulted in higher mortality in this group.
Therefore, we recommend a re-evaluation of current procalcitonin values in order to improve both survival rate as well as patient's quality of life in general.