Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

Abstract

Background Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. Results The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the fixed cut-offs to only one for mild to moderate and one for severe disease (0.25 μg/L and 0.5 μg/L, respectively). Further, guidance on interpretation of PCT results to initiate, withhold or discontinue ABx treatment was included. Conclusions A combination of clinical patient assessment with PCT levels in well-defined ABS algorithms, in context with continuous education and regular feedback to all ABS stakeholders, has the potential to improve the diagnostic and therapeutic management of patients suspected of bacterial infection, thereby improving ABS effectiveness.

Procalcitonin levels versus Microbiological profile in Central line associated bloodstream infections (CLABSI) of patients on Hemodialysis

“…One such strategy is to use PCT guided antibiotic therapy. [34][35][36] One of the largest studies conducted in this aspect was the use of procalcitonin to de-escalate antibiotic therapy, in acutely ill patients (PRORATA) trial, 37 a randomized controlled trial involving seven ICUs , where the criterion for stopping antibiotics was a decrease of PCT ≥ 80% from its peak value . concluding that PCT guided strategy was effective in reducing antibiotic exposure without any apparent adverse outcomes.…”

Biomarker auf der Intensivstation

“…für schwer erkrankte Patienten wurde jeweils ein Cut-off-Wert für Procalcitonin etabliert (0,25 µg/l resp. 0,5 µg/l), was die praktische Umsetzung erleichtert [22].…”

Procalcitonin (PCT) – ein Biomarker in der Sepsisdiagnostik

“…Für das Überleben sind sowohl das rasche Erkennen der Symptome wie auch anschließend die Identifizierung der Erreger mit unverzüglicher Einleitung der richtigen Therapie von absoluter Priorität. Die erfolgreiche Behandlung einer Sepsis hängt ganz entscheidend von der Qualität und dem Zeitpunkt ihrer Diagnose ab [4,5,15,19,21,24], für welche mit dem Parameter PCT ein hilfreiches Tool etabliert wurde.…”