Presepsin as a guide to antimicrobial therapy in cardiac surgery

• Published in: Journal of cardiothoracic and vascular anesthesia 2023-10, Vol.37, p.26-26
• Main Authors: KARAN, Radmila, KOCICA, Milica, BELJIC, Nevena, KACAR, Mirjana, CUMIC, Jelena, KOVACEVIC-KOSTIC, Natasa, CVETKOVIC, Dragan, KOCICA, Mladen, MARKOVIC, Dejan
• Format: Article
• Language: English
• ISSN: 1053-0770
• DOI: 10.1053/j.jvca.2023.08.063

Sepsis is the main cause of death in general ICUs at present day. About 19 million anually aquire sepsis worldwide and more than 30% dies. Only half of the septic patients is treated according to highest standards including west Europe. Biggest challange in treating sepsis is recognizing infection and timely initiation of antibiotic therapy. Biomarker with diagnostic, prognostic and therapeutic value could help topple this challenge. At the moment Presepsin was shown to have these values. Presepsin cut-off value for predicting sepsis is 600 pg/ml. We present 2 cases where Presepsin helped in diagnosing Infection, Initiating antibiotic therapy and correction of antibiotic therapy. Case 1. Female patient, 64 years old, CABG surgery, developed sepsis during hospitalization. On a 4th postoperative day,patient developed chills, fever, WBC increased, PCT 22.5 ng/ml. Hemocultires were obtained. In cosultation with infectologist cefepime and teicoplanin was initiated. The following morning (5th postoperative day), Patient`s condition deteriorated more, Presepsin was done (4262 pg/ml), Hemocultures obtained again. Antibiotic therapy was changed to Meropenem, Metronidazole, Teicoplanin. On a 6th postoperative day, patient improved, no fever, clinically stable. Presepsin on 7th postoperative day was 1216. Hemocultures came positive on 8th postoperative day (CNS, Serratia) sensitive to the ongoing antibiotic therapy, presepsin wa 678pg/ml. On 11th postoperative day, which was 8th day of triple antibiotic therapy Presepsin was 361pg/ml. Patient was on the triple antibiotic therapy for 10 days, sterile hemocultures came on 12th postoperative day. Patient was discharged in good clinical condition, infection free, 16 days after surgery. Case 2. Patient, male, 68 years old, EF-22%; CABG and aortic valve replacement surgery, During hospitalization patient developed infection. Antibiotic therapy was initiated according to the blood culture results (Pseudomonas (Meropenem) and CNS(Vancomycin). This was followed by the subsiding of signs of infection, decrease in inflammatory parameters, and clinical improvement. In the mean time sputum culture came positive (Acinetobacter) which was sensitive only to Collistin. Presepin value was 242pg/ml and it was decided against initiation of Collistin. Patient was dischared in good clinical condition without laboratory and clinical signs of infection. Presepsin could be a reliable tool for early distinguishment of patients with the risk o