procalcitonin in bacteraemia
Last edited 07/2022 and last reviewed 08/2022
- procalcitonin is a prohormone of calcitonin that has been reported to be present in increased levels in the blood of infected patients
- the ability to accurately and rapidly identify patients with bacteraemia
is an important management issue for emergency physicians
- a potential use of the procalcitonin test in the emergency department
(ED) is as a screening test for bacteraemia
- young children are often unable to localize their infection and the management, disposition, and prognosis all change according to the presence or absence of bacteraemia
- in adults, approximately 50% of patients evaluated in the ED with undifferentiated hypotension or hypotension of uncertain cause are ultimately diagnosed with sepsis
- a potential use of the procalcitonin test in the emergency department
(ED) is as a screening test for bacteraemia
- a systematic review investigated the test characteristics of procalcitonin
as a marker for bacteraemia (1)
- the authors found the diagnostic performance of the procalcitonin test for identifying bacteremia in ED patients to be moderate
- however
- an individual study in patients with exacerbations of COPD revealed
evidence for the use of the test in identifying patients who required
antibiotic treatment (2)
- the study included 208 patients randomized at the index exacerbation
to procalcitonin-guided or standard antibiotic therapy
- patients receiving procalcitonin-guided therapy were treated with antibiotics according to serum procalcitonin levels; standard-therapy patients received antibiotics according to the attending physician
- procalcitonin guidance reduced antibiotic prescription (40% vs 72%, respectively; p < 0.0001) and antibiotic exposure (relative risk [RR], 0.56; 95% confidence interval [CI], 0.43 to 0.73; p < 0.0001) compared to standard therapy
- procalcitonin guidance at the index exacerbation allowed a significant sustained reduction in total antibiotic exposure for up to 6 months (RR, 0.76; 95% CI, 0.64 to 0.92; p = 0.004)
- the authors concluded that procalcitonin guidance for exacerbations of COPD offers a sustained advantage over standard therapy in reducing antibiotic use for up to 6 months with a number-needed-to-treat of 3
- the study included 208 patients randomized at the index exacerbation
to procalcitonin-guided or standard antibiotic therapy
- an individual study in patients with exacerbations of COPD revealed
evidence for the use of the test in identifying patients who required
antibiotic treatment (2)
- a systematic review investigated the accuracy of serum procalcitonin as
a diagnostic test for sepsis, severe sepsis, or septic shock in adults in
intensive care units or after surgery or trauma, alone and compared with
C-reactive protein (3)
- the study authors concluded that procalcitonin represents a good biological
diagnostic marker for sepsis, severe sepsis, or septic shock, difficult
diagnoses in critically ill patients. Based on the study resulst, procalcitonin
was superior to C-reactive protein
- the study authors concluded that procalcitonin represents a good biological
diagnostic marker for sepsis, severe sepsis, or septic shock, difficult
diagnoses in critically ill patients. Based on the study resulst, procalcitonin
was superior to C-reactive protein
- a randomized controlled trial investigated the use of procalcitonin level-guided
treatment in exacerbations of COPD (4)
- the study revealed that procalcitonin guidance for exacerbations of
COPD offered a sustained advantage over standard therapy in reducing
antibiotic use for up to 6 months with a number-needed-to-treat of 3
- the study revealed that procalcitonin guidance for exacerbations of
COPD offered a sustained advantage over standard therapy in reducing
antibiotic use for up to 6 months with a number-needed-to-treat of 3
- a randomized controlled trial in primary care relating to the treatment
of acute respiratory tract infection (5):
- revealed that procalcitonin-guided therapy markedly reduces antibiotic use for acute respiratory tract infections in primary care without compromising patient outcome
- authors suggest that procalcitonin-guided therapy could be achieved
with 1 to 2 procalcitonin measurements in patients for whom the physician
intends to prescribe antibiotics
- evidence shows that procalcitonin-guided care can reduce antibiotic use without increasing infection or harm in patients with acute pancreatitis (6)
Reference:
- Jones AE et al. Procalcitonin Test in the Diagnosis of Bacteremia: A Meta-analysis.Ann Emerg Med. 2006 Dec 8.
- Stolz D et al. Antibiotic Treatment of Exacerbations of COPD: A Randomized, Controlled Trial Comparing Procalcitonin-Guidance With Standard Therapy. Chest. 2007 Jan;131(1):9-19
- Uzzan B et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med. 2006 Jul;34(7):1996-2003.
- Stolz D et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest. 2007 Jan;131(1):9-19.
- Briel M et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Intern Med. 2008 Oct 13;168(18):2000-7; discussion 2007-8
- Siriwardena A et al. A procalcitonin-based algorithm to guide antibiotic use in patients with acute pancreatitis (PROCAP): a single-centre, patient-blinded, randomised controlled trial . Lancet Gastroenterology & Hepatology 2022 DOI: https://doi.org/10.1016/S2468-1253(22)00212-6