Michele Bartoletti1, Massimo Antonelli2, Francesco Arturo Bruno Blasi3, Ivo Casagranda4, Arturo Chieregato5, Roberto Fumagalli6, Massimo Girardis7, Filippo Pieralli8, Mario Plebani9, Gian Maria Rossolini10, Massimo Sartelli11, Bruno Viaggi12, Pierluigi Viale1, Claudio Viscoli13, Federico Pea14,15. 1. Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. 2. UOC Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica (UOC) Fondazione Policlicnico Universitario A. Gemelli-Università Cattolica del Sacro Cuore, Rome, Italy. 3. Department of Pathophysiology and Transplantation, Università degli studi di Milano, UOC broncopneumologia, IRCCS Fondazione, "Cà Granda" Policlinico, Milan, Italy. 4. Dipartimento di Emergenza ed Accettazione, Azienda Ospedaliera "Santi Antonio e Biagio e C. Arrigo", Alessandria, Italy. 5. Neurorianimazione, Ospedale Niguarda Ca' Granda, Milan, Italy. 6. Anestesia e rianimazione I, Ospedale Niguarda Ca' Granda, Milan, Italy. 7. Anestesia e Rianimazione I, Dipartimento chirurgia generale e specialità chirurgiche, Azienda Ospedaliero-Universitaria di Modena - Policlinico, Modena, Italy. 8. Subintensiva di Medicina, - Azienda Ospedaliero Universitaria Careggi, Florence, Italy. 9. UO Medicina di Laboratorio, Azienda Ospedale-Università di Padova, Padua, Italy. 10. Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze e SOD Microbiologia e Virologia-Azienda Ospedaliero Universitaria Careggi, Florence, Italy. 11. UO Chirurgia Generale, Dipartimento Chirurgia maggiore oncologica, Ospedale di Macerata, Macerata, Italy. 12. NeuroAnestesia e Rianimazione, Dipartimento di Anestesia, Azienda Ospedaliero Universitaria Careggi, Firenze, Florence, Italy. 13. Clinica Malattie Infettive, Università di Genova e Ospedale Policlinico San Martino, IRCCS per l'Oncologia, Genova, Italy. 14. Institute of Clinical Pharmacology, Santa Maria della Misericordia University Hospital of Udine, ASUIUD, Udine, Italy. 15. Department of Medicine, University of Udine, Udine, Italy.
Abstract
BACKGROUND: Procalcitonin (PCT) is a useful biomarker of bacterial infection and its use is associated to reduced duration of antibiotic therapy in the setting of intensive care medicine. To address the need of practical guidance for the use of PCT in various clinical settings, a group of experts was invited to participate at a consensus process with the aims of defining the rationale for appropriate use of PCT and for improving the management of critically ill patients with sepsis. METHODS: A group of 14 experts from anesthesiology and critical care, infectious diseases, internal medicine, pulmonology, clinical microbiology, laboratory medicine, clinical pharmacology and methodology provided expert opinion through a modified Delphi process, after a comprehensive literature review. RESULTS: The appropriateness of use of PCT in terms of diagnosis, prognosis and antimicrobial stewardship was assessed for different scenarios or settings such us management of infection in the emergency department, regular wards, surgical wards or in the intensive care unit. Similarly, appropriateness and timing of PCT measurement were evaluated. All the process consisted in three Delphi rounds. CONCLUSIONS: PCT use is appropriate in algorithms for antibiotic de-escalation and discontinuation. In this case, reproducible, high sensitive assays should be used. However, initiation or escalation of antibiotic therapy in specific scenarios, including acute respiratory infections, should not be based solely on PCT serum levels. Clinical and radiological findings, evaluation of severity of illness and of patient's characteristics should be taken into proper account in order to correctly interpret PCT results.
BACKGROUND: Procalcitonin (PCT) is a useful biomarker of bacterial infection and its use is associated to reduced duration of antibiotic therapy in the setting of intensive care medicine. To address the need of practical guidance for the use of PCT in various clinical settings, a group of experts was invited to participate at a consensus process with the aims of defining the rationale for appropriate use of PCT and for improving the management of critically illpatients with sepsis. METHODS: A group of 14 experts from anesthesiology and critical care, infectious diseases, internal medicine, pulmonology, clinical microbiology, laboratory medicine, clinical pharmacology and methodology provided expert opinion through a modified Delphi process, after a comprehensive literature review. RESULTS: The appropriateness of use of PCT in terms of diagnosis, prognosis and antimicrobial stewardship was assessed for different scenarios or settings such us management of infection in the emergency department, regular wards, surgical wards or in the intensive care unit. Similarly, appropriateness and timing of PCT measurement were evaluated. All the process consisted in three Delphi rounds. CONCLUSIONS: PCT use is appropriate in algorithms for antibiotic de-escalation and discontinuation. In this case, reproducible, high sensitive assays should be used. However, initiation or escalation of antibiotic therapy in specific scenarios, including acute respiratory infections, should not be based solely on PCT serum levels. Clinical and radiological findings, evaluation of severity of illness and of patient's characteristics should be taken into proper account in order to correctly interpret PCT results.
Authors: Anne Marie Dupuy; Anne Sophie Bargnoux; Aneta Andreeva; Charlie Zins; Nils Kuster; Stéphanie Badiou; Jean Paul Cristol Journal: Pract Lab Med Date: 2019-10-26