£2m trial seeks to inform better use of antibiotics in sepsis

The University of Liverpool is to lead a new £2 million pound study looking at use of antibiotics in sepsis.

Sepsis is a potentially life-threatening complication of an infection and it is estimated that 52,000 people in the UK die every year as a result of it. Optimal treatment includes early recognition, prompt antibiotics and fluids.

The trial will look at emergency assessment of sepsis and whether antibiotics are being oversubscribed, which experts cite as a significant factor leading to increasing antimicrobial resistance.

Chief investigator Professor Neil French at the University of Liverpool, said: “We know that inappropriate use of antibiotics creates problems for the future generating antimicrobial resistance. We also know that antibiotics can create their own problems for individuals. We have to use antibiotics far more smartly and we need the best possible evidence to do this. The trial will provide the necessary evidence to ensure the best possible use of antibiotics in sepsis.”

Cardiff University’s Centre for Trials Research will coordinate the trial. Dr Emma Thomas-Jones, a senior research fellow at the centre said: “The aim of the trial is to assess whether the addition of a point-of-care blood test can aid clinicians in their decision-making around the requirement for urgent antibiotic treatment in patients presenting to the emergency department with suspected sepsis, which will hopefully lead to a reduction in antibiotic usage without increasing risk of mortality.”

Professor Enitan Carrol, a member of The National Institute for Health and Care Excellence’s (NICE) sepsis guideline development group, and co-applicant on the trial, said: “Sepsis guidelines recommend urgent antibiotics for suspected cases and since their introduction, have led to a 50% increase in broad spectrum intravenous antibiotic use adult in adult emergency departments.

“This is contributing to increased antimicrobial resistance. Further stratification is needed to decide which patients really need intravenous antibiotics within an hour, and which can wait whilst further assessments are conducted. Our trial could help answer this question.”

The trial will look at whether Procalcitonin (PCT), a blood test not widely used in the NHS, could improve assessment of sepsis when combined with the National Early Warning Score (NEWS), which is used in 90% of English hospitals.

Adults with suspected sepsis in 10 NHS hospitals will be randomly assigned the current standard of care and PCT-supported care, as part of the trial.

The Procalcitonin and NEWS evaluation for timely identification of sepsis and optimal use of antibiotics (PRONTO) study, which starts in December 2019, will last for three years.

The project is funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme.