The role of serum procalcitonin in the diagnosis of bacterial meningitis in adults: a systematic review and meta-analysis

Vikse, Jens; Henry, Brandon Michael; Roy, Joyeeta; Ramakrishnan, Piravin Kumar; Tomaszewski, Krzysztof A.; Walocha, Jerzy

doi:10.1016/j.ijid.2015.07.011

Cited by 67 publications

(47 citation statements)

References 56 publications

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“…Two recent meta-analyses confirmed PCT’s accuracy in differentiating viral from bacterial meningitis [73, 74]. The most recent meta-analysis from 2016 included 2058 subjects and showed a sensitivity of 0.95 (95% CI 0.89–0.97), a specificity of 0.97 (95% CI 0.89–0.99), a positive likelihood ratio of 31.7 (95% CI 8.0–124.8), and a negative likelihood ratio of 0.06 (95% CI 0.03–0.11).…”

Section: Introductionmentioning

confidence: 98%

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Sager

Kutz

Müeller

et al. 2017

BMC Med

240

181

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Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i.e., pneumonia). In these indications, PCT levels measured on hospital admission were found to substantially reduce the initiation of antibiotic treatment in low-risk situations (i.e., bronchitis, chronic obstructive pulmonary disease exacerbation). For more severe infections (i.e., pneumonia, sepsis), antibiotic stewardship by monitoring of PCT kinetics resulted in shorter antibiotic treatment durations with early cessation of therapy. Importantly, these strategies appear to be safe without increasing the risk for mortality, recurrent infections, or treatment failures. PCT kinetics also proved to have prognostic value correlating with disease severity (i.e., pancreatitis, abdominal infection) and resolution of illness (i.e., sepsis). Although promising findings have been published in these different types of infections, there are a number of limitations regarding PCT, including suboptimal sensitivity and/or specificity, which makes a careful interpretation of PCT in the clinical context mandatory. This narrative review aims to update clinicians on the strengths and limitations of PCT for patient management, focusing on research conducted within the last 4 years.

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Section: Introductionmentioning

confidence: 98%

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Sager

Kutz

Müeller

et al. 2017

BMC Med

240

181

View full text Add to dashboard Cite

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“…[30,31] Serum CRP and procalcitonin are useful markers as well, with the latter carrying a strong diagnostic odds ratio. [32,33] Molecular diagnostic testing, such as nuclear acid amplification tests, has been shown to facilitate the diagnosis in 33% of patients in whom the diagnosis could not be made conventionally. [34] Other future diagnostic aids may include immunochromographic testing, and the use of complement component 3, apolipoprotein A-1 and kinnogen-1.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic challenges with acellular bacterial meningitis

Moolla

Naidoo

2016

S Afr Med J

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“…When compared with bacterial culture, PCR is much less affected by pretreatment with antibiotics, with one study showing sensitivity of 89% in samples collected on days 1-3 of antibiotic treatment, 70% on days 4-6 and 33% on days 7-10. 36 PCT is particularly helpful in the diagnosis of early bacterial meningitis as it becomes detectable within 3-4 h of onset of symptoms, compared with the 12-24 h that CRP takes to rise. 34 Lactate, procalcitonin and C-reactive protein CSF lactate, serum procalcitonin (PCT) and serum Creactive protein (CRP) may be helpful in distinguishing bacterial from non-bacterial meningitis.…”

Section: Meningitis In Adultsmentioning

confidence: 99%

Meningitis in adults: diagnosis and management

Young

Thomas

2018

Internal Medicine Journal

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Bacterial meningitis is a medical emergency. All clinicians who provide acute medical care require a sound understanding of the priorities of managing a patient with suspected meningitis during the first hour. These include obtaining blood cultures, performing lumbar puncture and initiating appropriate therapy, while avoiding harmful delays such as those that result from not administering treatment until neuroimaging has been performed. Despite the increasing availability of newer diagnostic techniques, the interpretation of cerebrospinal fluid parameters remains a vital skill for clinicians. International and local guidelines differ with regard to initial empirical therapy of bacterial meningitis in adults; the North American guideline recommends ceftriaxone and vancomycin for all patients, while the Australian, UK and European guidelines recommend that vancomycin only be added for patients who are more likely to have pneumococcal meningitis or who have a higher likelihood of being infected with a strain of Streptococcus pneumoniae with reduced susceptibility to ceftriaxone. Patients with risk factors for Listeria meningitis also require an anti‐Listeria agent, such as benzylpenicillin, to be added to this treatment regimen. Dexamethasone should be a routine component of empirical therapy due to its proven role in reducing morbidity and mortality from pneumococcal meningitis.

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The role of serum procalcitonin in the diagnosis of bacterial meningitis in adults: a systematic review and meta-analysis

Abstract: Serum PCT is a highly accurate diagnostic test that can be used by physicians for rapid differentiation between bacterial and viral causes of meningitis in adults.

Cited by 67 publications

References 56 publications

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Diagnostic challenges with acellular bacterial meningitis

Meningitis in adults: diagnosis and management

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