Case Study

Sepsis: When Can I Safely Stop Antibiotics? 

Shawn Depcinski, PharmD, Antibiotic Stewardship

Age, sex:

42-year-old male

Chief complaint:

Right upper quadrant abdominal pain, weakness, temperature 39.1°C

Significant medical history: Gastroesophageal reflux disease (GERD), obesity

 

Admission labs, diagnostics:

Lactate 5.2 mmol/L, elevated liver function test, abdominal ultrasound

Admitting diagnosis:

Admitted with ascending cholangitis due to common bile duct stone

Treatment, interventions:

Blood cultures and PCT ordered, piperacillin-tazobactam started

Change in clinical status:

Later that day, blood pressure dropped to a mean arterial pressure of 57 mmHg, the sepsis protocol was initiated with fluid resuscitation and patient transferred to the ICU. The patient received an emergent placement of a percutaneous biliary drain by interventional radiology.
PCT level = 45.2μg/L.

New diagnosis:

Severe sepsis

Day 3:

PCT = 22.8 μg/L, blood cultures negative, and the patient was improving clinically on piperacillin-tazobactam. Patient was transferred back to the floor.

Day 5:

The biliary drain had minimal drainage and was removed. Elevated fever and white count had resolved. PCT = 5.8 μg/L, which represented a more than 80% reduction from the peak PCT value and lead to the discontinuation of antibiotics.

Day 6:

Discharged home.

Key takeaways


National guidelines often provide ranges for antibiotic treatment duration for infectious diseases, such as 4 to 7 days from source control for intra-abdominal infections from the Infectious Disease Society of America (IDSA).1

 

It can be difficult to determine a patient-specific duration of therapy, and many providers err on the side of caution by prescribing at the upper range of recommended days of therapy. Trending PCT can provide insight on an individual basis, regarding when the infection has resolved to the point where antibiotics can be safely discontinued.

 

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References
  1. Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010 Jan 15;50(2):133-64.