UHW Emergency Unit's PRONTO Trial Recruits over 100 patients

Sepsis is a common and potentially life-threatening complication of bacterial infection and early recognition and prompt intravenous (IV) antibiotics are important for optimising outcomes.

However, many patients presenting to the Emergency Unit with suspected sepsis subsequently do not have an underlying bacterial infection and therefore will not benefit from antibiotics. As it is difficult to distinguish who does and who does not have a bacterial infection initially, often antibiotics are prescribed ‘just in case’. Overuse of antibiotics is associated with antimicrobial resistance, which is judged to be a major threat to human health over the coming decades, therefore getting the balance right of when to use antibiotics is essential.

As a result, Cardiff and Vale University Health Board’s Emergency Unit launched the PRONTO Trial in July 2021, with the aim of improving sepsis care, patient outcomes and optimising antibiotic use in patients with suspected sepsis. Detailed information on the trial and its aims can be viewed in this video.

Managed by Cardiff University’s Centre for Trials Research (CTR), and sponsored by the University of Liverpool, the PRONTO Trial is currently recruiting patients at UHW and to date has successfully enrolled over 100 patients with suspected sepsis.

Using the National Early Warning Score (NEWS2) to initially identify the patients most at risk, the trial team at UHW are researching whether point of care testing (PoCT) of procalcitonin, a blood test that helps to identify a bacterial infection, at the bedside improves patient outcomes and antibiotic use.

This test enables clinicians to better risk stratify the response to suspected sepsis and help to guide the decision making process to avoid unnecessary use of antibiotics.

The PRONTO trial team are based in the Emergency Unit at UHW, enabling the unit to continue to deliver unscheduled care whilst also offering patients the opportunity to be part of a multi-centre UK trial with minimal disruption.

Dr Jonathan Underwood, Principal Investigator and Infectious Diseases Consultant at University Hospital of Wales, commented: “Our two dedicated research nurses, Lauren Thomas and Non Smith, are embedded within our Emergency Unit, enabling them to identify patients rapidly who may be eligible for this trial. They have been fantastic and are the main reason why this trial has been such a success and we have seen such great patient recruitment. Despite the challenges the Emergency Unit is facing, we are still delivering innovative research that will improve the quality and the future of care of patients with sepsis.”

“The pandemic has emphasised the importance of clinical trials for improving patient outcomes. Continuing to do research despite the challenges faced is important not only to benefit the patients in the trials, but also to encourage better outcomes and improved care more generally. We have seen an improvement in sepsis measures across the board since the trial began, which is largely down to the hard work of Lauren and Non.”

Speaking on achieving the milestone of recruiting over 100 patients to the PRONTO Trial, Non Smith, Clinical Nurse Specialist at University Hospital of Wales, explained: “Having been a nurse for over 20 years, I am really pleased to be able to contribute to the potential future of sepsis treatment in such a progressive way. It is interesting to be a part of the trial team, conduct forward-thinking research and make a difference in a challenging environment.”

PRONTO is a multi-centre trial, funded by the NIHR-HTA programme (ref17/136/13), led by Professor Neil French at the University of Liverpool and is currently managed by Cardiff University’s Centre for Trials Research.

For more information, please visit this Centre for Trials Research page on Cardiff University’s website.