Using Procalcitonin to Guide Antibiotic Therapy

Abstract

Procalcitonin levels rise in response to systemic inflammation, especially of bacterial origin. Multiple randomized controlled trials have demonstrated that procalcitonin-based algorithms can safely reduce antibiotic use in 2 clinical scenarios. First, in stable, low-risk patients with respiratory infections, procalcitonin levels of <0.25 µg/L can guide the decision to withhold antibiotics or stop therapy early. Second, in critically ill patients with suspected sepsis, clinicians should not initially withhold antibiotics, but procalcitonin levels of <0.5 µg/L or levels that decrease by ≥80% from peak can guide discontinuation once patients stabilize. The recent stop antibiotics on procalcitonin guidance study (SAPS), the largest procalcitonin trial to date, demonstrated reduction in both antibiotic exposure and mortality in critically ill patients. Although procalcitonin is ready for routine use, future research should examine optimal strategies for implementation in hospitals, its real-world impact on clinical outcomes and costs, its applicability to immunocompromised patients, and the generalizability of trials to the US population.

Combining Procalcitonin and Rapid Multiplex Respiratory Virus Testing for Antibiotic Stewardship in Older Adult Patients With Severe Acute Respiratory Infection

“…Multiple randomized controlled trials have demonstrated that PCT levels of <0.25 mg/L can guide the decision to withhold antibiotics or stop therapy early. 19,20 Since the approval of FilmArray respiratory panel tests, only a few studies have evaluated the clinical impact after implementation of the multiplex PCR respiratory panel on patients with less severe acute reparatory illness. 8,13e15 To date, no study has focused on older adults with severe acute respiratory illness.…”

Antibiotic Consumption, Resistance Data, and Prevention Strategies

“…The use of combination therapies is recommended for patients who develop severe sepsis/septic shock due to these MDR pathogens and for immunocompromised or febrile neutropenic septic patients and septic patients hospitalized in ICUs. Randomized clinical trials investigating the efficacy of combination therapies currently in use are needed [94,99] .…”

Potential Biomarkers for Predicting Bloodstream Bacterial Infection in Tanzanian Children

“…This practice could influence negative blood culture results which were initially considered as gold standard and thus reference point for the analysis of the performance of the biomarkers. In addition, it may not be possible to anticipate the influence the antibiotics might have on the expression and half-life of specific biomarkers in blood [16,20].…”

“…Currently, many authorities recommends use of PCT as clinical guide for diagnosis of sepsis in emergency situations prior to administration of antibiotic therapy [15]. Moreover, serum levels of PCT correlates well with the degree of infectious load and can safely be used as a guide for dose deescalating or discontinuation of antibiotic use [16]. In order to improve predictive value of markers for bloodstream bacterial infections, one approach is the combination of prediction rules of different tests for clinical and laboratory markers [17].…”