Procalcitonin for individualizing antibiotic treatment: an update with a focus on COVID-19

Abstract

Procalcitonin (PCT) is useful for differentiating between viral and bacterial infections and for reducing the unnecessary use of antibiotics. As the rise of antimicrobial resistance reaches “alarming” levels according to the World Health Organization, the importance of using biomarkers, such as PCT to limit unnecessary antibiotic exposure has further increased. Randomized trials in patients with respiratory tract infections have shown that PCT has prognostic implications and its use, embedded in stewardship protocols, leads to reductions in the use of antibiotics in different clinical settings without compromising clinical outcomes. However, available data are heterogeneous and recent trials found no significant benefit. Still, from these trials, we have learned several key considerations for the optimal use of PCT, which depend on the clinical setting, severity of presentation, and pretest probability for bacterial infection. For patients with respiratory infections and sepsis, PCT can be used to determine whether to initiate antimicrobial therapy in low-risk settings and, together with clinical data, whether to discontinue antimicrobial therapy in certain high-risk settings. There is also increasing evidence regarding PCT-guided therapy in patients with coronavirus disease 2019 (COVID-19). This review provides an up-to-date overview of the use of PCT in different clinical settings and diseases, including a discussion about its potential to improve the care of patients with COVID-19.

The Role of COVID-19 in Antibiotic Resistance in Pediatric Population

“…В целях улучшения рационального использования антибиотиков руководства больниц должны включать определение уровня прокальцитонина в тактику диагностики для последующего лечения [54]. Дальнейший обзор литературы выявил, что последовательная оценка в динамике с большой точностью может позволить исключить сепсис на ранней стадии [55]. Эти инициативы помогут предотвратить распространение лекарственно-устойчивых заболеваний, которые способны вызвать серьезные последствия в области общественного здравоохранения.…”

“…Несмотря на то, что измерение прокальцитонина помогает уменьшить применение антимикробных препаратов, существует проблема в выявлении внебольничных бактериальных инфекций. Рекомендации, основанные на динамике прокальцитонина, должны применяться индивидуально в зависимости от сопутствующих заболеваний пациента, а также от компетенций лечащего врача [54,55].…”

SARS‐CoV‐2 infection and multi-organ system damage: a review

“…Therefore, prescribing antibiotics in COVID-19 patients should be well elucidated to reduce the mortality rate and antibiotic resistance. As a potential marker to differentiate between viral and bacterial infections, the PCT can help prevent the unnecessary use of antibiotics [ 22 ].…”

Ultrasensitive Photoelectrochemical Immunoassay Strategy Based on Bi2S3/Ag2S for the Detection of the Inflammation Marker Procalcitonin

“…Procalcitonin (PCT) is an effective marker of blood infection that can be used to guide antibiotic treatment and disease evaluation in patients with respiratory system infections and blood flow infections [ 1 , 2 ]. The PCT levels increase when the patient has inflammation and infection, since the endocrine cells in the lungs and intestinal tissue synthesize and secrete large amounts of PCT [ 3 , 4 ]. The more serious the infection, the higher the PCT content [ 5 , 6 ].…”