Diagnostic Accuracy of Procalcitonin and C-reactive Protein for the Early Diagnosis of Intra-abdominal Infection After Elective Colorectal Surgery

Cousin, François; Ortega‐Deballon, Pablo; Bourredjem, Abderrahmane; Doussot, Alexandre; Giaccaglia, Valentina; Fournel, Isabelle

doi:10.1097/sla.0000000000001545

Cited by 95 publications

(83 citation statements)

References 41 publications

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“…The dynamics of postoperative Procalcitonin (PCT) are slightly different to those of CRP, with similar findings as in our study (14,34). Early elevation of measurable PCT (on the first or second postoperative days, for example), will be non-specific and reflect bacterial contamination or translocation secondary to bowel preparation.…”

Section: Discussionsupporting

confidence: 79%

“…An almost identical level of CRP and its postoperative timing and sensitivity for the diagnosis of AL was recently reported by Scepanovic et al (33). Several studies have compared CRP at different time points following colorectal surgery (12) where Cousin et al (34) found a greater discrimination with CRP for AL diagnosis by the 5th postoperative day. Such timing might be too late, however, for surgical teams, which discharge their patients earlier than this time point as part of their policy of REfEREnCES:…”

Section: Discussionsupporting

confidence: 56%

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Risk factors and inflammatory predictors for Anastomotic Leakage following Total Mesorectal Excision with defunctioning stoma

et al. 2018

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 56%

Risk factors and inflammatory predictors for Anastomotic Leakage following Total Mesorectal Excision with defunctioning stoma

et al. 2018

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“…Although the negative predictive value was found to be high, which may help to ensure early discharge [57], the specificity was quite low. Also, a meta-analysis including 2692 patients after colorectal surgery showed no advantage of PCT compared to CRP regarding diagnostic accuracy and mortality prediction [58]. This was confirmed recently in a similar large prospective study including 501 patients [59].…”

Section: Introductionmentioning

confidence: 76%

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Sager

Kutz

Müeller

et al. 2017

BMC Med

235

181

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Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i.e., pneumonia). In these indications, PCT levels measured on hospital admission were found to substantially reduce the initiation of antibiotic treatment in low-risk situations (i.e., bronchitis, chronic obstructive pulmonary disease exacerbation). For more severe infections (i.e., pneumonia, sepsis), antibiotic stewardship by monitoring of PCT kinetics resulted in shorter antibiotic treatment durations with early cessation of therapy. Importantly, these strategies appear to be safe without increasing the risk for mortality, recurrent infections, or treatment failures. PCT kinetics also proved to have prognostic value correlating with disease severity (i.e., pancreatitis, abdominal infection) and resolution of illness (i.e., sepsis). Although promising findings have been published in these different types of infections, there are a number of limitations regarding PCT, including suboptimal sensitivity and/or specificity, which makes a careful interpretation of PCT in the clinical context mandatory. This narrative review aims to update clinicians on the strengths and limitations of PCT for patient management, focusing on research conducted within the last 4 years.

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“…19 Table 2 describes additional information regarding the sensitivity and specificity of PCT in aiding in the diagnosis of a variety of disease states. [20][21][22][23][24][25][26][27][28][29][30][31] In addition to contributing to accurate diagnoses, PCT levels were shown to correlate with the extent and severity of microbial invasion, with higher PCT levels indicative of poorer prognosis. 32,33 PCT levels greater than 1 ng/ml at any point during a study of 427 patients hospitalized in the ICU were associated with increased mortality.…”

Section: Evidence For Procalcitonin As a Diagnostic And Prognostic Dementioning

confidence: 99%

Procalcitonin Monitoring as a Guide for Antimicrobial Therapy: A Review of Current Literature

2018

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Effective antimicrobial stewardship practices are increasingly essential to best utilize the current arsenal of antimicrobials for the shortest necessary duration to minimize the development of antimicrobial resistance, secondary infections, and health care costs. Monitoring of serum procalcitonin (PCT) levels represents an effective antimicrobial stewardship strategy to differentiate bacterial infections from viral infections and noninfectious inflammatory conditions. Current literature illustrates the merits of PCT monitoring in reducing duration of antibiotic therapy without detrimental effects on mortality or infection relapses. However, the interpretation of PCT levels can be challenging, especially in light of comorbid disease states that can elevate PCT levels. This review sheds light on the utility of PCT monitoring, as well as providing insight into the practical interpretation of PCT levels. Much of the current literature surrounding PCT monitoring consists of use among patients with lower respiratory tract infections or in the critically ill. Overall, studies have demonstrated shorter antibiotic therapy durations when PCT monitoring is utilized. No studies to date have found increased rates of mortality or infection relapses, suggesting that PCT monitoring is not only effective, but also safe when used as a guide for antimicrobial therapy. Nonetheless, many conditions were shown to elevate PCT serum concentrations, even in the absence of bacterial infections, which can make interpretation of PCT concentrations challenging. Two common conditions that affect the accurate interpretation of PCT levels are renal dysfunction and congestive heart failure. Limited studies have been performed in these populations, but current available data propose the need for higher PCT thresholds in those with renal dysfunction or congestive heart failure and support utilizing PCT trends to monitor clinical improvement from bacterial infections. Evidence also suggests that PCT monitoring is cost-effective, as long as the test is ordered judiciously. In summary, PCT monitoring represents a promising antimicrobial stewardship strategy to limit exposure to unnecessary antimicrobial therapy.

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Diagnostic Accuracy of Procalcitonin and C-reactive Protein for the Early Diagnosis of Intra-abdominal Infection After Elective Colorectal Surgery

Abstract: Levels of inflammatory markers under the cutoff value between postoperative days 3 and 5 ensure safe early discharge after elective colorectal surgery. Procalcitonin seems not to have added value as compared to C-reactive protein in this setting.

Cited by 95 publications

References 41 publications

Risk factors and inflammatory predictors for Anastomotic Leakage following Total Mesorectal Excision with defunctioning stoma

Risk factors and inflammatory predictors for Anastomotic Leakage following Total Mesorectal Excision with defunctioning stoma

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Procalcitonin Monitoring as a Guide for Antimicrobial Therapy: A Review of Current Literature

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