The main objective of providing treatment to patients is to relieve symptoms along with decreasing the progression of the disease as well as the mortality or morbidity. However, in some cases, this objective is not fully achieved, especially in the case of the patients who are admitted to the ICU with some serious and almost always a terminal stage of the disease. For example, when old patients are admitted in the ICU, their immunity is extremely low and this is the perfect time for the opportunistic infections to make matters worse for these patients. There are many infections that are specifically associated with patients admitted in the hospitals. Pseudomonas Aurigeonosa is a micro-organism that is well documented to cause bacterial pneumonia and bacteremia in the patients who are terminally ill and are receiving treatment in the hospital setting. Since most of the patients in the ICU are not conscious or are in a comatose state, it becomes very difficult for the doctors and the nursing staff to make an early diagnosis of the aforementioned infections. By the time the doctors and the paramedics find out about the deteriorating conditions of the patients because of the opportunistic pathogens, it is usually too late to save the lives of the patients.
Definition of Important Terms
Before we start the discussion based on the PICO question, we will briefly define some of the key terms that will often be used in this paper. First of all, the term "adult patients" has been used in the question. It can be used in two different contexts. Firstly, it can be used in the sense that the adult patients are most prone to infections since they have a depressed immune system. Secondly, it can be implied in the sense that adult patients are the ones who are mostly admitted to the ICU ward of any hospital with usually a terminal disease or a very serious one.
The term "critically ill" would be used many times in this paper. It is used to refer to patients who have been admitted to the ICU with a potentially fatal disease or are in the terminal stages of any disease.
The second key term that has been used in the question is "bacteremia." Bacteremia refers to the presence of bacteria, of any strain or nature, in the circulating bloodstream that has the potential to cause systemic infections whose outcome is normally sepsis or what is commonly known as septic shock.
"Bacterial pneumonia" is basically the infection of the lungs or the lower respiratory tract. The causative agent has to be a bacterium, be it gram positive or gram negative.
The term "adjunctive measurement" has been used with respect to the measurement of pro-calcitonin in systemic infections. This implies that there are some diagnostic tools that have to be used to start treating patients who have developed bacteremia or bacterial pneumonia. However, there are some other diagnostic tools that are also sometimes referred to as the "surrogate markers" that can help the doctors and other nursing staff in the early diagnosis of a condition that can be potentially fatal for the patients who are critically ill.
The question on whose response this paper will be based on revolves around the adult patients that have been admitted in the ICU and are therefore terminally ill. These patients almost always develop bacteremia or bacterial pneumonia because of which their condition becomes worse and their survival rate also decreases. The purpose of this question is to figure out that whether or not the adjunctive measurement of pro-calcitonin levels can be helpful in the early diagnosis of bacteremia and bacterial pneumonia so that these patients could be promptly and appropriately treated so that their mortality/morbidity could be reduced. After reviewing the available literature, the question can be answered.
Researchers are working day in and day out to devise the tests or the assessment techniques that would make it possible for the clinical professionals to make an early diagnosis of such infections in these patients so that their lives could be saved and a reduction in morbidity could be made. One of such diagnostic criteria that the researchers have come up with is the adjunctive measurement of pro-calcitonin levels. In this paper, we shall discuss how this method and its alternatives can help save the lives of the patient. Apart from this, we shall also look at some of the statistics pertaining to the deaths of critically ill patients due to bacteremia. After analyzing the available data, we will make a conclusion that whether or not the measurement of pro-calcitonin levels is of benefit or whether the data is just inconclusive. At the end of the paper, we shall also answer the PICO question.
Relevance to clinical practice
As mentioned in first part of the paper, the doctors and the paramedic staff are quite concerned about the patients who are admitted in the ICU going into septic shock because of the opportunistic infections. Once the patients develop septicemia or bacteremia, it becomes very difficult to save their lives. In this part of the paper, we see why it is so important for the researchers and the doctors to find out a way through which an early diagnosis of the invasion by pathogens can be made so that the mortality and morbidity can be decreased and the lives of the patients can be saved.
Most of the patients that are admitted to the ICU are normally very old. This means that their immunity is extremely low. Moreover, since they are in the ICU, they are suffering from some serious disease for which they are receiving strong medications that further suppresses their immunity. Under such circumstances, the opportunistic bacteria invade the body and can potentially cause life threatening septicemia or bacterial pneumonia. It is indeed very difficult for the doctors to treat these patients if the diagnosis is not made in the very early stages. Even though fever and dropping blood pressure could be signs of developing bacteremia, these signs are not specific enough for the doctors to make a specific diagnosis. Therefore, the need of time is the development of specific methods for the early diagnosis of worsening health such as the measurement of the pro-calcitonin levels. The next step would be to appropriately treat the patients with bacterial pneumonia and bacteremia.
According to the theory, the automated continuous-monitoring systems allow the doctors and the nursing staff to detect the bacterial invasion just a few hours after the withdrawal of the blood sample. Nonetheless, in actual clinical practice, it takes at least 12 to 24 hours to obtain the result for Gram stain after the blood is drawn from the patient. This is one of the main reasons why the chances are high that the outcome could be worse and the patients have to stay longer in the hospital ICU. On the other hand, the new methods including the polymerase chain reaction allow the doctors to identify the bacteria reliably and quickly but unfortunately, the facility for conducting such tests is not available in most of the clinical centers. There is no doubt in the fact that the clinical manifestations are the best approach to make a diagnosis, but the recently discovered surrogate markers can offer great assistance in identifying the main human bacterial strains within the first few hours of management of patients who have developed bacteremia.
According to a study that was based on 147 patients admitted in five different ICUs, it was found out that the most common source of infection was that of the lower respiratory tract. This implied that 32.0% of the patients who were infected with opportunistic pathogens developed lower respiratory tract symptoms. Some of the drugs that were tested for the treatment of these infections included ceftazidime, imipenem and cirpfloxacin. The aforementioned were the drugs that were found to be the most effective against the bacteria that were isolated from the blood cultures of the patients admitted in the ICUs. The independent risk factors pertaining to mortality were considered to be the development of septic shock and fatal underlying conditions. According to the results, treatment with the appropriate antibiotic did not prove to be of significant help in increasing the survival of these patients. The findings of this study suggested that the prevention of bacterial pneumonia and lower respiratory tract colonization are very critical for decreasing the incident of hospital acquired gram negative septicemia in the ICU patients. The most significant risk factors for death are the underlying disease and septic shock (Jang et. al, 1999).
Effectiveness of Evidence
Serum pro-calcitonin, also known as PCT is a peptide based on 116 amino acids. There has been a strong association between elevation of PCT and systemic bacterial infections. The measurement of serum PCT depends upon a fast and routine laboratory test that has the documented ability to distinguish between non-infectious acute inflammatory conditions and systemic bacterial infection (Digiovine et. al, 1999). On…