A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand

A CHENG, D Limmathurotaskul, W Chierakul, N Getchalarat, Vanaporn Wuthiekanun, D STEPHENS, N Day, N WHITE, W Chaowagul, Bart Currie, S PEACOCK

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    Abstract

    Background. Melioidosis is a tropical infectious disease associated with significant mortality. Most deaths occur early and are caused by fulminant sepsis. Methods. In this randomized, placebo-controlled trial, we assessed the efficacy of lenograstim (granulocyte colony-stimulating factor [G-CSF], 263 ?g per day administered intravenously) in ceftazidime-treated patients with severe sepsis caused by suspected melioidosis in Thailand. Results. Over a 27-month period, 60 patients were enrolled to receive either G-CSF (30 patients, 18 of whom had culture-confirmed melioidosis) or placebo (30 patients, 23 of whom had culture-confirmed melioidosis). Mortality rates were similar in both groups (G-CSF group, 70%; placebo group, 87%; risk ratio, 0.81; 95% confidence interval, 0.61-1.06; P = .2), including among patients with confirmed melioidosis (83% vs. 96%; P = .3). The duration of survival was longer for patients who received G-CSF than for patients who received placebo (33 h vs. 18.6 h; hazard ratio, 0.56; 95% confidence interval, 0.31-1.00; P = .05). Conclusions. Receipt of G-CSF is associated with a longer duration of survival but is not associated with a mortality benefit in patients with severe sepsis who are suspected of having melioidosis in Thailand. We hypothesize that G-CSF may "buy time" for severely septic patients, but survival is more likely to be improved by management of associated metabolic abnormalities and organ dysfunction associated with severe sepsis. � 2007 by the Infectious Diseases Society of America. All rights reserved.
    Original languageEnglish
    Pages (from-to)308-314
    Number of pages7
    JournalClinical Infectious Diseases
    Volume45
    Issue number3
    Publication statusPublished - 2007

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    CHENG, A., Limmathurotaskul, D., Chierakul, W., Getchalarat, N., Wuthiekanun, V., STEPHENS, D., Day, N., WHITE, N., Chaowagul, W., Currie, B., & PEACOCK, S. (2007). A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand. Clinical Infectious Diseases, 45(3), 308-314.