Procalcitonin (PCT), the precursor peptide of the hormone calcitonin, is released ubiquitously in response to primarily bacterial toxins and bacteria-specific proinflammatory mediators, particularly interleukin 1b, tumor necrosis factor, and interleukin 6. Recently, studies have shown that PCT guidance of antibiotic therapy reduced antibiotic consumption by almost 50% in patients suspected of having either a community-acquired pneumonia or chronic obstructive pulmonary disease exacerbation.1-3 The same strategy was also recommended for critically ill patients suspected of developing an infectious process.
In a recently published study, the authors sought to determine whether antibiotic consumption differs between patients with PCT guidance and those without PCT guidance for the decision to treat. This was a single-center, prospective, randomized controlled trial in five intensive care units (ICUs) from a tertiary care hospital. All patients hospitalized for >48 hours in the ICU during a 9-month period were included. Procalcitonin serum level was obtained for all patients suspected to have infection either on admission or during their ICU stay.4
A total of 258 patients in the PCT group and 251 patients in the control group were included. The authors observed a significant amount of withheld treatment in the PCT group of patients classified by the intensive care unit clinicians as having possible infection but this did not reduce antibiotic consumption. The treatment days were 62.6 ± 34.4% and 57.7 ± 34.4% of the ICU stays in the PCT and control groups, respectively (p = .11) According to the infectious-disease physician, 33.8% of the cases in which no infection was confirmed had a PCT value >1μg/L and 14.9% of the cases with confirmed infection had PCT levels <0.25 μg/L.
The authors therefore concluded that PCT did not help improve concordance between the diagnostic confidence of the infectious-disease physician and the ICU physician and that the use of PCT as an indicator for the initiation of antimicrobials did not help reduce antibiotic consumption in the ICU.
1. Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet
2. Christ-Crain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: A randomized trial. Am J Respir Crit Care Med
3. Stolz D, Christ-Crain M, Bingisser R, et al. Antibiotic treatment of exacerbations of COPD: A randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest
4. Layios N, Lambermont B, Canivet JL, et al. Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients. Crit Care Med 2012;40:2304–2309.