Procalcitonin to guide antibiotic therapy in the ICU.
Int J Antimicrob Agents. 2015 Dec;46 Suppl 1:S19-24.
Bréchot N1, Hékimian G2, Chastre J2, Luyt CE2.
1Service de Réanimation Médicale, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47 boulevard de l’Hôpital, 75651 Paris Cedex 13, France; INSERM U1050, Centre interdisciplinaire de recherche en biologie – College de France, 11 Place Marcelin Berthelot, 75231 Paris Cedex 05, France. Electronic address: email@example.com.
2Service de Réanimation Médicale, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris 6, 47 boulevard de l’Hôpital, 75651 Paris Cedex 13, France; INSERM, UMRS-1166, Institute of Cardiometabolism and Nutrition (iCAN), Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, 47 bd de l’Hôpital, 75651 Paris Cedex 13, France.
The serum procalcitonin (PCT) concentration reflects both the systemic response to bacterial infection and its severity. However, its accuracy in distinguishing intensive care unit (ICU) patients with and without infection remains low owing to a lack of specificity and the time lapse between infection onset and the PCT rise.
Hence, PCT cannot be used as a marker to start or withhold antibiotic therapy for ICU patients.
However, the kinetics of the PCT concentration decrease under antibiotic therapy can adequately monitor infection evolution with therapy and can help to customise antibiotic duration.
PCT-guided algorithms to guide antibiotic discontinuation were able to shorten antibiotic duration without impacting patient outcomes in several multicentre randomised studies.
Notably, antibiotics can be stopped very early when PCT is low and remains low as this indicates that bacterial infection is unlikely.
When PCT falls to <0.5ng/mL or >80% from its peak value, antibiotics for non-localised infections can safely be stopped.