Implementation of Procalcitonin in Antibiotic Stewardship: Derivation of a Consensus Algorithm for Procalcitonin Use in Clinical Practice

Abstract

Reducing antibiotics overuse is essential to minimize antibiotics related side effects and to prevent the emergence of multidrug-resistant bacteria. Procalcitonin (PCT) guided antibiotics therapy has been reported to be safe in patients with acute respiratory infections and sepsis, improving clinical outcomes as well as reducing the duration of antibiotics use. However, there is still no universal agreement on clinical guidelines in Korea for optimal PCT applications. Through this expert consensus meeting, clinical research findings in the PCT-guided antibiotics treatment interventions and real-world clinical applications were discussed. From the perspective of antibiotic stewardship, PCT application target groups, cut-offs, and testing cycles were discussed to reach a consensus on the PCT-guided antibiotics treatment algorithm for application in Korea. Combining clinical assessment for patients with an appropriate PCT-guided antibiotics treatment algorithm could improve the diagnosis and treatment of acute respiratory infections and sepsis. In addition, continuous education and regular feedback would improve the effectiveness of antibiotic stewardship.

Implementing antimicrobial stewardship: lessons and perspectives from a university-affiliated tertiary hospital in Korea

“…Additionally, we initiated qualitative evaluations of long-term prescriptions of oral antibiotics and interventions to control the duration of injectable antibiotic administration based on each patient's condition and indications. Moreover, biomarker-integrated ASP activities are in preparation in our hospital based on recent reports that a procalcitonin level-based ASP approach decreased antibiotic use [38][39][40][41].…”

Role of biomarkers in antimicrobial stewardship: physicians’ perspectives

“…The guideline states that biomarkers can be used to discontinue antibiotics. Subsequent guideline suggests a consensus algorithm for PCT use in clinical antimicrobial stewardship [ 16 ], in which antibiotics can be started or stopped based on PCT levels when an infectious disease is suspected. The cut-off for PCT is 0.5 μg/L in patients with sepsis and 0.25 μg/L in those with respiratory tract infections.…”

Antibiotic Stewardship in Surgical Departments

“…Guidelines may fail to offer a clear indication for proper antibiotic use, and doctors do not always adhere to the guidelines, exhibiting defensive treatment practices. In addition, the cooperation between surgeons and the AS team may vary, and surgeons may fail to use laboratory resources and inflammatory biomarkers effectively [41,[43][44][45]. As a result, antibiotic prescription in surgery lacks clarity and occurs in settings of disjointed information and low policy adherence [45].…”

“…In addition, the cooperation between surgeons and the AS team may vary, and surgeons may fail to use laboratory resources and inflammatory biomarkers effectively [41,[43][44][45]. As a result, antibiotic prescription in surgery lacks clarity and occurs in settings of disjointed information and low policy adherence [45]. Despite the multiple campaigns aimed at creating awareness of the consequences of overprescribing, antimicrobial consumption densities remain significant higher in comparison to the percentage of patients with infection in surgical ICUs [41].…”