O Neeser1, A Branche2, B Mueller3, P Schuetz4. 1. Department of Internal Medicine, Kantonsspital Aarau, Switzerland. 2. Department of Medicine, University of Rochester Department of Medicine, Rochester General Hospital, Rochester, NY, USA. 3. Department of Internal Medicine, Kantonsspital Aarau, Switzerland; University of Basel, Basel, Switzerland. 4. Department of Internal Medicine, Kantonsspital Aarau, Switzerland; University of Basel, Basel, Switzerland. Electronic address: Philipp.Schuetz@unibas.ch.
Abstract
BACKGROUND: Adding procalcitonin (PCT) to antibiotic stewardship algorithms may improve antibiotic use. However, PCT protocols need to be adapted to clinical settings and patient populations. OBJECTIVES: To review PCT use in different medical settings and patient populations. SOURCES: Most recent trials and meta-analyses investigating PCT for antibiotic stewardship were reviewed. CONTENT: Several trials found PCT-guided antibiotic stewardship to reduce antibiotic exposure and associated side-effects among patients with respiratory infection and sepsis. Decisions regarding antibiotic use in an individual patient are complex and should be based on the pre-test probability for bacterial infection, the severity of presentation and the results of PCT. In the context of a low pre-test probability for bacterial infections and a low-risk patient, a low PCT level helps to rule out bacterial infection and empiric antibiotic therapy can be avoided. In the context of a high pre-test probability for bacterial infections and/or a high-risk patient with sepsis, monitoring of PCT over time helps to track the resolution of infection and decisions regarding early stop of antibiotic treatment. Although these concepts have been successful in several respiratory infection and sepsis trials, some studies failed to show an added benefit of PCT due to factors such as low protocol adherence and relying on single rather than repeat PCT measurements. IMPLICATION: As an adjunct to other clinical and laboratory parameters, PCT provides information about risk for bacterial infection and resolution of infection, and improves antibiotic stewardship decisions, thereby offering more individualized treatment courses with overall reduced antibiotic exposure.
BACKGROUND: Adding procalcitonin (PCT) to antibiotic stewardship algorithms may improve antibiotic use. However, PCT protocols need to be adapted to clinical settings and patient populations. OBJECTIVES: To review PCT use in different medical settings and patient populations. SOURCES: Most recent trials and meta-analyses investigating PCT for antibiotic stewardship were reviewed. CONTENT: Several trials found PCT-guided antibiotic stewardship to reduce antibiotic exposure and associated side-effects among patients with respiratory infection and sepsis. Decisions regarding antibiotic use in an individual patient are complex and should be based on the pre-test probability for bacterial infection, the severity of presentation and the results of PCT. In the context of a low pre-test probability for bacterial infections and a low-risk patient, a low PCT level helps to rule out bacterial infection and empiric antibiotic therapy can be avoided. In the context of a high pre-test probability for bacterial infections and/or a high-risk patient with sepsis, monitoring of PCT over time helps to track the resolution of infection and decisions regarding early stop of antibiotic treatment. Although these concepts have been successful in several respiratory infection and sepsis trials, some studies failed to show an added benefit of PCT due to factors such as low protocol adherence and relying on single rather than repeat PCT measurements. IMPLICATION: As an adjunct to other clinical and laboratory parameters, PCT provides information about risk for bacterial infection and resolution of infection, and improves antibiotic stewardship decisions, thereby offering more individualized treatment courses with overall reduced antibiotic exposure.
Authors: Luis García de Guadiana-Romualdo; Daniel Morell-García; Cristian Morales-Indiano; Josep Miquel Bauça; María José Alcaide Martín; Clara Esparza Del Valle; Jose I Gutiérrez Revilla; Eloisa Urrechaga; José M Álamo; Ana M Hernando Holgado; María-Carmen Lorenzo-Lozano; Silvia Sánchez Fdez-Pacheco; Patricia de la Hera Cagigal; María A Juncos Tobarra; Juan A Vílchez; Isabel Vírseda Chamorro; Irene Gutiérrez Garcia; Yolanda Pastor Murcia; Laura Sahuquillo Frías; Laura Altimira Queral; Elisa Nuez-Zaragoza; Juan Adell Ruiz de León; Alicia Ruiz Ripa; Paloma Salas Gómez-Pablos; Iria Cebreiros López; Amaia Fernández Uriarte; Álex Larruzea; María L López Yepes; Patricia Esteban Torrella; María C Zamorano Andrés; Jose Pedregosa Díaz; Cristina Acevedo Alcaraz; Alfonso-L Blazquez-Manzanera; Ana M L Padilla Jiménez; María C Baamonde Calzada; Marina Vera; Matilde Cháfer Rudilla; Magdalena Canalda Campás; Sara García Muñoz; Luis Vicente Gutiérrez; Laura Jiménez Añón; Alfonso Pérez Martínez; Aurelio Pons Castillo; Ruth González Tamayo; Jorge Férriz Vivancos; Olaia Rodríguez-Fraga; Vicente Ferrer Díaz de Brito Fernández; Vicente Aguadero; María G García Arévalo; María Arnaldos Carrillo; Mercedes González Morales; María Núñez Gárate; Cristina Ruiz Iruela; Natalia Sancho-Rodríguez; Marti Vila Pérez; José M Egea-Caparrós; Luis Sáenz; Álvaro Blasco Barbero; Amparo Galán Ortega Journal: Scand J Clin Lab Invest Date: 2021-02-16 Impact factor: 1.713
Authors: Eva Heilmann; Claudia Gregoriano; Djillali Annane; Konrad Reinhart; Lila Bouadma; Michel Wolff; Jean Chastre; Charles-Edouard Luyt; Florence Tubach; Angela R Branche; Matthias Briel; Mirjam Christ-Crain; Tobias Welte; Caspar Corti; Evelien de Jong; Maarten Nijsten; Dylan W de Lange; Jos A H van Oers; Albertus Beishuizen; Armand R J Girbes; Rodrigo O Deliberato; Stefan Schroeder; Kristina B Kristoffersen; Nathalie Layios; Pierre Damas; Stella S S Lima; Vandack Nobre; Long Wei; Carolina F Oliveira; Yahya Shehabi; Daiana Stolz; Michael Tamm; Alessia Verduri; Jin-Xiang Wang; Sabine Drevet; Gaetan Gavazzi; Beat Mueller; Philipp Schuetz Journal: Age Ageing Date: 2021-09-11 Impact factor: 10.668