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Use of procalcitonin as an aid to antibiotic prescribing in intensive care
Critical Care volume 12, Article number: P181 (2008)
Procalcitonin (PCT) is increasingly used as a specific marker for bacterial infection and sepsis. It has been shown to increase the accuracy of sepsis diagnosis at an early stage. PCT levels are low in viral infections, chronic inflammatory disorders or autoimmune processes. PCT levels in sepsis are generally greater than 1–2 ng/ml and often reach values between 10 and 100 ng/ml. An audit was carried out to ascertain whether a change in antibiotic prescribing occurred when PCT results were used in conjunction with white cell count (WCC) and C-reactive protein (CRP).
The audit was carried out over a 1-month period. All patients with suspected infection had their WCC, CRP and PCT measured. The consultant intensivist was blinded to the PCT result and asked for their management plan on the basis of all other blood tests and clinical assessment. The PCT result was then revealed and the management plan was then re-evaluated.
A total of 100 PCT tests were carried out on 30 patients. The PCT result did change management 26% of the time. The PCT result led to an omission of antibiotics, which would otherwise have been given in eight out the 30 tests. The PCT result also led to continuation of antibiotics, which otherwise would have been changed in 10 out of 16 tests. The number of continuations of antibiotics was higher after PCT (65 post PCT and 52 pre PCT) but this is related to the fact that 10 of these would have had alteration of antibiotics. See Figure 1.
The use of PCT had a useful role in changing antibiotic prescribing in 26% of instances. Most commonly it leads to patients not having antibiotics initiated or reducing the change in antibiotics once started.
Tang , et al: Accuracy of procalcitonin for sepsis diagnosis. Lancet Infect Dis. 2007, 7: 210-217. 10.1016/S1473-3099(07)70052-X.
Uzzan , et al: Procalcitonin as a diagnostic test for sepsis in crtically ill adults. Crit Care Med. 2006, 34: 1996-1920. 10.1097/01.CCM.0000226413.54364.36.
BRAHMS PCT International. [http://www.procalcitonin.com]
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Fletcher, A., Moondi, P. Use of procalcitonin as an aid to antibiotic prescribing in intensive care. Crit Care 12, P181 (2008). https://doi.org/10.1186/cc6402
- Bacterial Infection
- Management Plan
- Specific Marker
- Inflammatory Disorder