From the Guidelines
For patients with intra-abdominal infections (IAIs), I recommend using procalcitonin (PCT) levels as a guide to determine the timing and appropriateness of escalation or de-escalation of antimicrobial therapy, in conjunction with clinician judgment and laboratory information. The use of PCT has been suggested as a novel biomarker that may be useful in guiding therapeutic decision making in the management of sepsis, including IAIs 1. A systematic review and meta-analysis on PCT-guided therapy in ICU patients with severe sepsis and septic shock found that PCT-guided therapy significantly reduced the duration of antimicrobial therapy compared to standard treatment groups 1. However, the results of a prospective study in patients with peri-operative septic shock secondary to intra-abdominal infection suggested that PCT decrease to 0.5 ng/mL lacked sensitivity to predict the treatment response, and its role has not been defined in complicated IAIs (cIAIs) 1.
- Key points to consider when using PCT in IAIs include:
- PCT levels can be used to guide antimicrobial discontinuation, as recommended by the 2018 WSES/SIS-E consensus conference 1
- The addition of PCT to clinical symptoms and signs may strengthen the diagnosis and exclusion of pneumonia, but its use is not routinely recommended for outpatient adults with acute cough due to suspected pneumonia or influenza 1
- Clinician judgment and laboratory information should always be used in conjunction with PCT levels to determine the best course of treatment for patients with IAIs
- The optimal duration of antibiotic therapy for IAIs is not well established, but it is recommended to continue therapy until further debridement is no longer necessary, the patient has improved clinically, and fever has been resolved for 48-72 hours 1
In terms of specific treatment recommendations, the use of broad-spectrum empiric antimicrobial therapy is recommended for patients with IAIs, covering Gram-positive, Gram-negative, and anaerobic organisms, until culture-specific results and sensitivities are available 1. The choice of antibiotic therapy should be guided by local resistance patterns and patient-specific factors, such as the presence of underlying illnesses or immunocompromised status.
From the Research
Procamio Study Overview
- The Procamio study, published in the European heart journal in 2017 2, compared the safety and efficacy of intravenous procainamide and amiodarone for the acute treatment of tolerated wide QRS complex tachycardia.
- The study found that procainamide therapy was associated with less major cardiac adverse events and a higher proportion of tachycardia termination within 40 min.
Key Findings
- The primary endpoint, which was the incidence of major predefined cardiac adverse events within 40 min after infusion initiation, occurred in 9% of procainamide patients and 41% of amiodarone patients 2.
- Tachycardia terminated within 40 min in 67% of procainamide patients and 38% of amiodarone patients 2.
- In patients with structural heart disease, the primary endpoint was less common in procainamide patients (11% vs. 43%) 2.
Comparison with Other Studies
- The Procamio study is distinct from other studies, such as the one published in Nutrients in 2018 3, which investigated the effect of oral intake of low-molecular-weight collagen peptide on human skin hydration, elasticity, and wrinkling.
- The Procamio study focused specifically on the treatment of tolerated wide QRS complex tachycardia, whereas the Nutrients study examined the effects of collagen peptide supplementation on human skin.