Procalcitonin-guided antibiotic treatment in critically ill patients.
OBJECTIVE
In critically ill patients, length of antibiotic treatment can be effectively guided by procalcitonin (PCT) protocols. International sepsis guidelines and guidelines on antibiotic stewardship strategies recommend PCT as helpful laboratory marker for a rational use of antibiotics. A number of studies and meta-analyses have confirmed the effectiveness of PCT-protocols for shortening antibiotic treatment without compromising clinical outcome in critically ill patients. But in clinical practice, there is still uncertainty how to interpret PCT levels and how to adjust antibiotic treatment in various infectious situations, especially in the perioperative period.


METHODS
This narrative review gives an overview on the application of PCT-protocols in critically ill patients with severe bacterial infections on the basis of 5 case reports and the available literature. Beside strengths and limitations of this biomarker, also varying kinetics and different maximum values with regard to the infectious focus and pathogens are discussed.


RESULTS
PCT-guided antibiotic treatment appears to be safe and effective. Most of the studies revealed a shorter antibiotic treatment without negative clinical outcomes. Cost effectiveness is still a matter of debate and effects on bacterial resistance due to shorter treatments, possible lower rates of drug-related adverse events, or decreased rates of Clostridium difficile infections are not yet evaluated.


CONCLUSIONS
Guidance of antibiotic treatment can effectively be supported by PCT-protocols. However, it is important to consider the limitations of this biomarker and to use PCT protocols along with antibiotic stewardship programmes and regular clinical rounds together with infectious diseases specialists.
Department of Anaesthesiology and Intensive Care Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany. andreas.hohn@uk-koeln.de.
Andreas
A
Hohn
Department of Infectiology and Hospital Hygiene, Hospital Düren gem. GmbH, Roonstraße 30, 52351, Dueren, Germany.
Bernhard
B
Heising
Department of Anaesthesiology, Surgical Intensive Care, Emergency Medicine and Pain Management, Hospital Düren gem. GmbH, Roonstraße 30, 52351, Düren, Germany.
Jan-Karl
JK
Schütte
Department of Anaesthesiology, Surgical Intensive Care, Emergency Medicine and Pain Management, Hospital Düren gem. GmbH, Roonstraße 30, 52351, Düren, Germany.
Olaf
O
Schroeder
Department of Anaesthesiology, Surgical Intensive Care, Emergency Medicine and Pain Management, Hospital Düren gem. GmbH, Roonstraße 30, 52351, Düren, Germany.
Stefan
S
Schröder
D000328:Adult; D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000097:blood / Q000188:drug therapy*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D002985:Clinical Protocols; D003422:Critical Care; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000097:blood* / Q000628:therapy*
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002116:Calcitonin
Antibiotic stewardship; Antibiotic treatment; Procalcitonin; Sepsis