Management of Intra-Abdominal Infections: The Role of Procalcitonin

Abstract

Patients with intra-abdominal sepsis suffer from significant mortality and morbidity. The main pillars of treatment for intra-abdominal infections are (1) source control and (2) early delivery of antibiotics. Antibiotic therapy should be started as soon as possible. However, the duration of antibiotics remains a matter of debate. Prolonged antibiotic delivery can lead to increased microbial resistance and the development of nosocomial infections. There has been much research on biomarkers and their ability to aid the decision on when to stop antibiotics. Some of these biomarkers include interleukins, C-reactive protein (CRP) and procalcitonin (PCT). PCT’s value as a biomarker has been a focus area of research in recent years. Most studies use either a cut-off value of 0.50 ng/mL or an >80% reduction in PCT levels to determine when to stop antibiotics. This paper performs a literature review and provides a synthesized up-to-date global overview on the value of PCT in managing intra-abdominal infections.

Comparative Characterization of Procalcitonin (Sensitivity, Specificity, Predictability, and Cut-Off Reference Values) as a Marker of Inflammation in Odontogenic Abscesses of the Head and Neck in the Female Population

“…In urological patients, PCT has been shown to be elevated in patients with bacterial pyelonephritis [ 16 ]. In abdominal surgery, PCT plasma concentration has been shown to increase in pancreatitis, peritonitis, appendicitis, and abdominal abscess [ 17 , 18 ]. The measurement of PCT concentration in patients with meningitis is used in neurology to distinguish bacterial from non-bacterial meningitis, and in bacterial such PCT is in values above the reference [ 19 , 20 ].…”

Antibiotic Stewardship in Surgical Departments

“…The percentage of resistant pathogens among the main bacteria responsible for SSIs has varied over time [38] (Table 2). Surgical intervention and proper antibiotic utilization have significantly reduced mortality rates in people with intra-abdominal infections [39]. The reduced consumption of antibiotics, along with rapid discontinuation and de-escalation to the oral route, is also accompanied by significant cost savings [40,41].…”

“…Patients with uncomplicated appendicitis (simple suppurative appendicitis without gangrene, perforation, or abscess) can be managed with antibiotic treatment alone [39]. The proposed duration of antibiotic treatment is 1-3 days of intravenous antibiotics, followed by 7-10 days of oral antibiotics [67].…”

“…Clinicians perceive antibiotic resistance to be a national problem but less relevant to their own institution [82]. Staff education comprises a very important part of antimicrobial AMS programs, but it may also be a challenge in LMICs [30,39,82]. Education may include continuous training programs on AMR, prescription instructions for surgical prophylaxis and treatment, and the distribution of algorithms on empirical therapy [40,66].…”

“…A multidisciplinary team of experts attempted to define the role of PCT across the surgical pathway and the ability of PCT-guided algorithms to assist AS programs in reducing antibiotic use [39,43]. They concluded that PCT may be useful in guiding the duration and cessation of antibiotics and consequently the exposure to them in patients with acute peritonitis [43,99].…”