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Case study 1 – resolution

The final step related to the ICU case study - the case is resolved.

In this final step, we will examine the patient’s response in the days following her operation.

On day 4 post-operation there were signs of respiratory compromise, with an increased respiratory rate and oxygen requirements. She experienced new onset abdominal pain, and a CT TAP scan found no new collection in the abdomen. The patient was found to have bibasal consolidation in the lungs, and no pulmonary embolism detected. Her CRP level was measured at 250 and PCT at 6.7, and on day 4 she experienced one temperature spike of 38.3°C.

Two questions were then considered:

  • Is a change in antibiotic appropriate?
  • Should any further diagnostics be used?

After considering these questions, the patient’s antibiotics were changed to piperacillin/tazobactam for 7 days.

On day 5 the patient had a marked improvement, with a CRP level of 180 and PCT of 2.8. Her blood pressure support was weaned and fraction of inspired oxygen (FiO2) was down.

On days 6-8 continued improvement was observed, and the patient was fit to be on the ward – she was eating and drinking, and out of bed with drains removed.

The measurements of CRP and PCT during these days were the following:

  • CRP – 120, 100, 80
  • PCT – 1.8, 0.9, 0.15

Throughout this case study the measurements of CRP and PCT assisted with decision making to ensure the patient was receiving appropriate treatment – leading her to leave ICU after 8 days.

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Procalcitonin: PCT as a Biomarker for Antimicrobial Stewardship

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