Procalcitonin for Antibiotic Treatment in Intensive Care Unit Patients

Abstract

Procalcitonin (PCT), a 116-aminoacids prohormone, has been substantially studied over the last 2 decades in the field of sepsis. Disappointingly low sensitivity values led to the abandonment of the concept of it as a diagnostic tool and then to its being considered more as a prognostic marker with a good correlation with severe infection. Later on, growing concerns about multidrug-resistant bacteria in the ICU environment and about the cost and side effects of antibiotics suggested that PCT might prove to be a valuable asset in stewardship programs. Numerous but hardly comparable randomized controlled trials assessing either initiation or deescalation in ICU patients have been published. Stewardship encompassing PCT should focus on the latter, because of the high negative predictive value of this biomarker. However, there still would be safety concerns if a systematic implementation of PCT were to be considered in daily stewardship programs in the ICU, especially in extrathoracic sepsis.

Challenges and opportunities for antibiotic stewardship among preterm infants

“…In intensive care unit, two trials in adult patients have studied antibiotic initiation based on procalcitonin (PCT)-guided algorithms. One study found no effect, and although the other found a significant reduction in antibiotic use,53 a 53% non-compliance in the PCT arm raised concerns about generalisability of the study 51 53 54. One trial in neonates found the addition of interleukin 8 (≥70 pg/mL) to standard management (clinical signs and C-reactive protein (CRP) >10 mg/L) among 1291 NICU admissions resulted in a reduction of antibiotic initiation for suspected EOS from 49.6% to 36.1% (p<0.001) without any ‘missed’ infections 55.…”

The Role of Procalcitonin in the Diagnosis and Prognosis of Severe Surgical Patients with Sepsis

“…The effects of antibiotics for treatment of sepsis can be assessed by monitoring PCT level, determining whether antibiotics should be continued or changed. PCT-guided decision making for suspected early-onset sepsis can safely reduce the duration and the using dosages of antibiotic treatment [5,10,11].…”