Peer Reviewed Journal: Treatment to Patients

Pages: 15 (4516 words)  ·  Bibliography Sources: 15  ·  Level: Master's  ·  Topic: Disease  ·  Buy This Paper

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[. . .] Furthermore, results have shown that the level of PCT increase has a close association with outcome in patients who are critically ill (Beekmann, 2003).

Some studies have also suggested that the elevation in the levels of PCT vary according to the underlying pathogen causing the infection. This implies that it is expected to achieve a different magnitude of elevation in serum PCT in cases of infective endocarditis, bacterial pneumonia and bacteremia (Luzzani et. al, 2003). Nonetheless, up till now, only a handful of conflicting results pertaining to a PCT magnitude, which has the capability to differentiate between Gram positive or Gram negative bacterial strains, have been issues when taking into consideration the patients who are critically ill and have simultaneously developed sepsis (Opal et. al, 1999). However, the fact that there are differences in the signaling pathways of the inflammatory response that is induced by the two species of the bacteria has been established. Since PCT elevation is considered to have an intricate relationship with the cytokine response of the host to the challenge offered by the microbes, it is assumed that the difference between the values of PCT according to the strain of bacteria is there since the onset of bacterial manifestation (Harbath et. al, 2001).

Analysis

It is indeed very important to improve survival in the critically ill patients with bacterial pneumonia and bacteremia, and is achieved by many interventions, the most important being the administration of broad spectrum antibiotics. Therefore, recent studies have been suggested that the "door-to-needle" time is a crucial factor pertaining to the survival of patients who have developed sepsis. Data collected as a result of clinical studies as well as the latest guidelines are helpful for the doctors when they have to choose a certain antibiotic for empiric treatment (Ibrahim et. al, 2000). Nonetheless, some researchers believe that in 25% of the cases, the antibiotic treatment was changed once the Gram stain results were received by the doctor. Therefore, surrogate markers make it possible for the doctors to choose the appropriate treatment rapidly (Munson et. al, 2003).

Findings of some studies have suggested that the value of PCT elevation has the potential to be significantly higher in patients who have developed Gram Negative bacteremia as compared to the patients with Gram Positive bacteremia. Furthermore, no variable was found to be confounding in the studies that have been conducted. It should be noted that some studies pertaining to the critically ill patients with sepsis have either not addressed the aforementioned issue or have not confirmed it as of now (Muller et. al, 2000). Nonetheless, some studies have suggested that in the patients with S. pneumonia manifestation, PCT was found to be more elevated than it was in GN bacteremia, such as in the case of Legionella, which is an atypical microbe (Prat et. al, 2006)). On the other hand, in the patients with infective endocarditis, it was established that PCT elevation was greater in cases of GN bacteremia as compared to GP bacteremia. The reason for these contradictory results could be the fact that in some studies, the patients were infected by more than one strain and type of bacteria. On the other hand, some authors have suggested and proved in their studies that in patients with established sepsis, PCT was significantly elevated as compared to patients who did not develop sepsis. Therefore, the differences could be more obvious in cases of such patients (Boussekey et. al, 2005).

Since it is thought that PCT is elevated in the blood in direct association with the host's immune response and the inflammatory mediators that are released as a defense mechanism against the offending pathogens, a different set of cytokine response could be responsible for the differences in the pattern of PCT elevation that have been mentioned in the previous paragraphs. The fact, that GN and GP bacteria are known to induce inflammatory responses that depend on different patterns of innate immunity, can support this hypothesis. Therefore, it was suggested that the function of Toll-like receptors in the whole blood response to different bacteria was significantly variable and relied upon the composition of the outer membrane of the offending pathogens. It should be noted that one of the main determinants of the results of Gram stain is the composition of the outer membrane. Therefore, it was seen that the magnitude of the cytokine response depended upon the nature of the invading bacteria. To be more precise, studies have shown that the Tumor necrosis factor-? (TNF-?) has a crucial role to play in the cytokine response to the invading pathogen. Nonetheless, the plasma levels of TNF are not necessarily increased irrespective of the causative pathogen. Since this cytokine plays a critical role in the release of PCT from different cell lines when there is systemic bacterial infection, it could be suggested that the magnitude of PCT elevation could somehow be related to the characteristics owned by the invading bacteria. Some studies have shown in vitro that the peak value of PCT was significantly increased in the supernatants of human cells that were cultured and stimulated with lipopolysaccharide as compared to the ones that were stimulated with muramyl dipeptide, which is a part of the outer membrane of the Gram positive bacteria (Tavares et. al, 2005). It was interesting to note that no significant difference was observed regarding the CRP kinetics. Moreover, studies have previously shown that Candida species circulating in the bloodstream were less likely to induce an elevation in the levels of serum PCT in patients who were critically ill patients as compared to bacteria circulating in the bloodstream. This could also be one of the reasons for the difference in immune response pattern (Charles et. al, 2006).

However, the results of all the studies that have been conducted in this regard should consider with caution. Firstly, the results of the aforementioned studies cannot be generalized to all patients who have developed sepsis since mostly those patients were included in these studies that had developed bacteremia and not necessarily sepsis. Secondly, the probable ratio of a positive test (being PCT less than 16.0ng/mL) is quite low and cannot be applied in a clinical setting with reliability. Thirdly, it was observed that the mortality rate was higher in patients with GN bacteremia as compared with the patients who were infected with GP bacterial strains. Since the magnitude of PCT elevation had a direct link with the severity of the disease and its prognosis, the doctors and nursing staff should never ignore the fact that the patients with GP manifestation are probably less critically ill as compared to the patients with GN pathogen invasion. Even though the SOFA score as well as the admission SAPS II were found to be comparable in patients with GP bacteremia and GN bacteremia, some differences in health status were noted (Garrouste-Orgeas, 2006). Moreover, the possibility that the patients with GP bacteremia were more likely to have received immunosuppressive drugs cannot be excluded. However, none of the patients in any of the studies that have been mentioned above were treated with any immunosuppressive drugs apart from the steroids once they developed septic shock. It should be noted here that the same number of patients from both the GP and GN group developed septic shock at the onset of bacteremia and therefore they were treated with hydrocortisone. Moreover, it has not been established whether or not patients with a depressed immune system tend to show lower levels of serum PCT when bacterial sepsis sets in. Lastly, it is noteworthy that the amount of soft tissue infections was greatly increased in patients with GP manifestation. Therefore, PCT measurement and clinical diagnosis can be made earlier in these patients, and lower levels of PCT could be obtained without considering the Gram stain results. Nonetheless, somewhat similar results can be obtained when the patients having soft tissue infections are not included in the analysis. Apart from this, a low PCT value has been shown to be consistently independent in association with GP bacteremia in a setting that includes soft tissues that are considered a source of infection.

Alternative Solutions to the Problem

The fact that terminally ill patients who are admitted to the ICU almost always develop bacteremia due to which they can develop bacterial pneumonia or these patients can also go into septic shock, has been established. Now the problem at hand is to develop a schema that would make it possible for the doctors to make an early diagnosis of bacterial pneumonia or bacteremia so that these patients can be appropriately and promptly be treated. On the other hand, it is also important for the doctors or the nursing staff to be well aware of the route of infection that leads to bacteremia or bacterial pneumonia. First of all, most of the GN bacteria and also some of the GP bacteria enter the system circulation when the… [END OF PREVIEW]

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Treatment to Patients.  (2013, July 19).  Retrieved March 19, 2019, from https://www.essaytown.com/subjects/paper/treatment-patients-main/3220254

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