Procalcitonin-guided antibiotic therapy: a potentially effective and efficient strategy

Plebani, Mario; Fabbri, Leonardo M.

doi:10.1515/cclm-2015-0061

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…Most of this research has concluded that IL-6, IL-8, IL-10, and CRP are non-specific in separating SIRS due to infection from non-infectious SIRS. However, procalcitonin levels are only mildly elevated in SIRS but become significantly elevated in sepsis and dramatically elevated with Gram-negative sepsis [ 10 , 11 ]. This finding, although initially reported by Assicot back in 1993, continued to mostly be under-utilized in the care of septic patients until recently, when the research in this area has greatly improved [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin-guided antibiotic therapy for septic patients in the surgical intensive care unit

Carr

2015

j intensive care

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In critically ill patients, elucidating those patients with the systemic inflammatory response syndrome (SIRS) from an infectious source (sepsis), versus those who have SIRS without infection, can be challenging since the clinical features are the same.Even with strict monitoring and testing, 39–98 % of patients with SIRS will never have bacteriological confirmation of an infection, and 6–17 % of patients with a documented infection will not show signs of SIRS. Due to this overlap, an extensive amount of research has been performed to investigate ways of determining and separating SIRS from infection, compared to SIRS due to trauma, surgical stress, or other non-infectious causes. This review article will discuss the recommended and peer-approved use of procalcitonin in septic patients in the intensive care unit and its use as a guide to antibiotic initiation and termination. The article will focus on the prospective randomized trials (Level 1 evidence) that have been conducted, and lesser levels of evidence will be referenced as needed to substantiate a conclusion.The literature documents multiple benefits of using procalcitonin as a guide to cost savings and appropriate termination of antibiotics by its use as a new objective marker of bacteremia that was previously not available. This article will show that antibiotics should be terminated when the procalcitonin level falls below 0.5 ng/mL.

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Section: Introductionmentioning

confidence: 99%

Procalcitonin-guided antibiotic therapy for septic patients in the surgical intensive care unit

Carr

2015

j intensive care

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“…Its measurement is widely available, eliminating the need for a highly specialised hospital laboratory. Moreover, laboratory sets for PCT are also more readily standardised, and results from different laboratories are easier to compare when contrasted with Ct because all available sets use the same antibodies, which lends itself to a higher level of performing measurements [14,16]. Finally, the results of PCT measurements are more readily available because it is an examination usually performed in urgent conditions, whereas the waiting period for the results of a Ct measurement is PRACE ORYGINALNE substantially longer.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of selected biochemical markers in the detection of recurrence of medullary thyroid cancer — comparison of calcitonin, procalcitonin, chromogranin A, and carcinoembryonic antigen

Woliński

Kaznowski

Klimowicz

et al. 2017

Endokrynologia Polska

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Our study confirms that PCT can be considered as an equivalent alternative for measurement of calcitonin. On the other hand, it is also worth noting that MTC can be a rare cause of very high levels of PTC not resulting from infectious diseases. The diagnostic value of CEA and chromogranin A is much lower and can be within the normal range even in patients with advanced, metastatic MTC. They should be used only as accessory markers.

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“…This feature of ProCT differs clearly from CT and has high relevance in clinical practice. Some limitations, however, affect ProCT determination; in fact, a marked increase in this molecule has been reported in systemic infections (mainly bacteriemia) and inflammatory diseases, and these conditions represent the main indications for ProCT measurement (Plebani & Fabbri 2015).…”

Section: Discussionmentioning

confidence: 99%

“…A relevant advantage of using ProCT assays is that all commercial assays yield quite similar results. One limitation might be that measurements of ProCT are not very widely available; however, because of its increasing use as a pivotal marker in internal medicine and antibiotic therapy, the availability of ProCT is expected to grow during the coming years (Plebani & Fabbri 2015). The most critical challenge is that further studies are needed to identify the optimal cutoff level of ProCT, so that active (i.e., recurrent/persistent) MTC cases can be distinguished from cured ones.…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin for detecting medullary thyroid carcinoma: a systematic review

Trimboli¹,

Seregni²,

Treglia³

et al. 2015

Endocrine-Related Cancer

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The aim of the present study was to perform a systematic review of published studies to provide a robust estimation of the use of procalcitonin (ProCT) as a diagnostic marker of medullary thyroid carcinoma (MTC), with particular focus on its specificity and negative predictive value in excluding MTC. A comprehensive computer literature search was conducted to find relevant published articles on the topic. We used a search algorithm based on a combination of the terms 'medullary,' 'thyroid,' and 'ProCT.' The search was updated until February 2015. To expand our search, references of the retrieved articles were also screened. A total of 39 articles were retrieved, of which nine original papers published from 2003 to 2014 were selected for the review. Some of these studies used ProCT in the preoperative diagnosis of MTC, whereas others measured ProCT during the follow-up of patients who had been previously treated for MTC. Other laboratory measurements were performed in some of the included studies. The results of the majority of the studies indicate that ProCT measurement appears to be a very promising and reliable serum marker for the diagnosis of MTC, and it is not inferior to calcitonin (CT). The sample handling is less laborious, and in the few CT-negative cases reviewed, the assay had even greater sensitivity. It would be worthwhile to establish cutoff levels using larger patient series, because we speculate that this assay could potentially replace CT measurement in the future.

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Procalcitonin-guided antibiotic therapy: a potentially effective and efficient strategy

Abstract: Comment on\ud \ud Economic evaluation of procalcitonin-guided antibiotic therapy in acute respiratory infections: a US health system perspective. [Clin Chem Lab Med. 2015

Cited by 6 publications

References 10 publications

Procalcitonin-guided antibiotic therapy for septic patients in the surgical intensive care unit

Procalcitonin-guided antibiotic therapy for septic patients in the surgical intensive care unit

Diagnostic value of selected biochemical markers in the detection of recurrence of medullary thyroid cancer — comparison of calcitonin, procalcitonin, chromogranin A, and carcinoembryonic antigen

Procalcitonin for detecting medullary thyroid carcinoma: a systematic review

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