Nobre et al used the serum procalcitonin (PCT) to help guide antibiotic therapy for a septic patient. This can shorten the duration of antbiotic therapy and the hospital stay without affecting patient safety. The authors are from the University of Geneva.
Patient selection: critically ill and septic
Initial therapy: parenteral antibiotics
Parameters:
(1) documented bacteremia in blood cultures
(2) initial serum procalcitonin concentration in µg/L
(3) followup day of antibiotic therapy
(4) serum procalcitonin concentration on the followup day
(5) clinical evidence of continuing severe infection
Bacteremia |
Initial PCT |
Followup |
Recommendation |
absent |
< 1 µg/L |
< 0.1 µg/L on day 3 |
discontinue antibiotics if no evidence of severe infection |
present |
NA |
see below |
at least 5 days of antibiotic therapy |
NA |
>= 1 µg/L |
< 0.25 µg/L on day 5 |
discontinue antibiotics if no evidence of severe infection |
NA |
>= 1 µg/L |
ratio of day 5 to day 0 < 0.1 |
discontinue antibiotics if no evidence of severe infection |
where:
• The ratio < 0.1 indicates a > 90% reduction.
• Procalcitonin was measured using the Kryptor PCT assay (Brahms AG)
Purpose: To use the serum procalcitonin concentration to guide antibiotic therapy in a patient who is critically ill and septic.
Specialty: Infectious Diseases, Pharmacology, clinical
Objective: options
ICD-10: A40, A41, A49.9,