الفهرس 
Definition of sepsis and septic shock.Only 14 pages are availabe for public view
 |  | from | 137 |  |  |
| | | from | 137 | | |
Abstract
Sepsis is an unusual systemic reaction to what is sometimes an ordinary infection. A hyperinflammatory response is followed by an immune-suppressive phase during which multiple organ dysfunctions is present and the patient is susceptible to nosocomial infection.
Biomarkers to diagnose sepsis may allow early intervention which, although primarily supportive, can reduce the risk of death. Although lactate is currently the most commonly used biomarker to identify sepsis, other biomarkers may help to enhance lactate’s effectiveness; these include markers of the hyper-inflammatory phase of sepsis, such as pro-inflammatory cytokines, chemokines, proteins such as C-reactive protein and procalcitonin which are synthesized in response to infection and inflammation and markers of neutrophil and monocyte activation.
Recently, markers of the immune-suppressive phase of sepsis, such as anti-inflammatory cytokines, and alterations of the cell surface markers of monocytes and lymphocytes have been examined. Combinations of pro- and anti-inflammatory biomarkers in a multi-marker panel may help identify patients who are developing severe sepsis before organ dysfunction has advanced too far. Combined with innovative approaches to treatment that target the immunosuppressive phase, these biomarkers may help to reduce the mortality rate associated with severe sepsis which, despite advances in supportive measures, remains high.
In the context of worldwide increasing antimicrobial resistance, good antimicrobial prescribing is more needed than ever; unfortunately, information available to clinicians often are insufficient to rely on.
Biomarkers might provide help for decision-making and improve antibiotic management. Routinely available biomarkers, which might be useful for antibiotic management during acute infections are currently limited to C-reactive protein (CRP) and procalcitonin (PCT).
Procalcitonin provides help in initiation and discontinuation of antibiotic therapy in sepsis in the ICU.
The role of procalcitonin in discontinuation of antibiotics is more prominent than its role in antibiotic initiation. Using procalcitonin in discontinuation of antibiotics resulted in shorter duration on antibiotic therapy, less side effects of antibiotics and without increase in mortality, length of stay, or relapsed/persistent infection.
Most studies in sepsis have evaluated using PCT to discontinue antibiotics but only one large trial used PCT levels to assist in the decision to initiate treatment. Because of limited data, the decision to initiate therapy in the ICU should be driven by the severity of illness and clinical assessment of the likelihood of infection with the PCT used as an adjunct to assist in the decision.