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Narrative Review for Clinical Microbiology and Infection "how to" How to: Implement procalcitonin testing in my practice.

Research paper by Olivia O Neeser, Angela A Branche, Beat B Mueller, Philipp P Schuetz

Indexed on: 08 Jan '19Published on: 08 Jan '19Published in: Clinical Microbiology and Infection



Abstract

Adding procalcitonin (PCT) to antibiotic stewardship algorithms may improve antibiotic use. PCT protocols, however, need to be adapted to clinical settings and patient populations. to review PCT use in different medical settings and patient populations. most recent trials and meta-analyses investigating PCT for antibiotic stewardship were reviewed. 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 is complex and should be based on the pretest probability for bacterial infection, the severity of presentation and results of PCT. In the context of a low pretest probability for bacterial infections and a low-risk patient, a low PCT levels aids in ruling-out bacterial infection and empiric antibiotic therapy can be avoided. In the context of a high pretest probability for bacterial infections and/or a high-risk patient with sepsis, monitoring of PCT over time helps to track resolution of infection and decisions regarding early stop of antibiotic treatment. While these concepts have shown to be 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. 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. Copyright © 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.