An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic therapy algorithms in adult critically ill patients

Abstract

Procalcitonin-guided antibiotic therapy algorithms could help in reducing the duration of antimicrobial administration without having a negative impact on survival.

Procalcitonin as diagnostic biomarker of sepsis

“…3 Several meta-analyses have assessed procalcitonin as a marker of sepsis. [4][5][6][7][8][9] The fi ndings of these reports confl ict with regards to the association between procalcitonin and improved patient outcomes-eg, adequate treatment, mortality, or length of stay in the intensive-care unit. These discrepancies are probably a result of confounders such as treatment and population heterogeneity, diagnostic challenges related to identifi cation of the causative pathogens, absence of a true reference standard, the complexity of sepsis, diff erences in assay sensitivity, and shortcomings in the methods of the studies with inadequate statistical power to detect changes for hard endpoints.…”

“…11 For situations of greatest clinical uncertainty, procalcitonin does not off er good enough negative predictive value to justify withholding antibiotic treatment-the patient could still have potentially life-threatening sepsis, in contrast to mild-tomoderate respiratory tract infection, for which withholding antibiotics is potentially less harmful. [7][8][9] This shortcoming has been shown in a clinical trial in France, 12 in which critical care physicians were reluctant to trust procalcitonin measurements for making initial treatment decisions for septic patients. The doctors often disregarded the procalcitonin result and started antimicrobial treatment, despite low baseline procalcitonin concentrations.…”

“…Procalcitonin is not a perfect biomarker but it is the best available means for making individualised treatment decisions to reduce duration of antibiotic treatment or withhold antibiotics for non-life-threatening respiratory tract infections. [7][8][9] We anxiously await the results of further clinical trials of procalcitonin and other biomarkers of sepsis, which will hopefully improve antibiotic stewardship strategies in intensive-care units. Finally, as with any other diagnostic test, the potential risk of overuse of procalcitonin should not be ignored since it could lead to increasing expenditures (ie, assay cost, use of additional cultures), false-positive results (ie, related to trauma or surgery), and unwarranted adverse eff ects.…”

“…Eight cases occurred in three clusters, and 13 required intensive care. In the UK cluster, three members of the same family were infected: one individual had recently travelled to Pakistan and Saudi Arabia, whereas the other two had no recent travel history, 8 suggesting person to person transmission. Although two of the cases had severe respiratory symptoms, one had mild symptoms suggesting a range of clinical expression.…”

“…Contacts of the UK cases have been identifi ed by the HPA and KSA-MoH, and follow-up tests have so far been negative for the molecular targets of the novel coronavirus. 8 Coronaviruses are very common, and widely dispersed in animals and in human beings. They can infect the respiratory tract, gut, liver, and CNS, causing a range of illnesses.…”