Abstract

Procalcitonin (PCT) is useful for differentiating between viral and bacterial infections and for reducing the unnecessary use of antibiotics. As the rise of antimicrobial resistance reaches “alarming” levels according to the World Health Organization, the importance of using biomarkers, such as PCT to limit unnecessary antibiotic exposure has further increased. Randomized trials in patients with respiratory tract infections have shown that PCT has prognostic implications and its use, embedded in stewardship protocols, leads to reductions in the use of antibiotics in different clinical settings without compromising clinical outcomes. However, available data are heterogeneous and recent trials found no significant benefit. Still, from these trials, we have learned several key considerations for the optimal use of PCT, which depend on the clinical setting, severity of presentation, and pretest probability for bacterial infection. For patients with respiratory infections and sepsis, PCT can be used to determine whether to initiate antimicrobial therapy in low-risk settings and, together with clinical data, whether to discontinue antimicrobial therapy in certain high-risk settings. There is also increasing evidence regarding PCT-guided therapy in patients with coronavirus disease 2019 (COVID-19). This review provides an up-to-date overview of the use of PCT in different clinical settings and diseases, including a discussion about its potential to improve the care of patients with COVID-19.

摘要

降钙素原 (PCT) 可用于区分病毒和细菌感染以及减少不必要的抗生素使用。根据世界卫生组织的说法，随着抗菌素耐药性的上升达到“令人震惊”的水平，使用 PCT 等生物标志物来限制不必要的抗生素暴露的重要性进一步增加。对呼吸道感染患者进行的随机试验表明，PCT 具有预后意义，并且它的使用嵌入到管理方案中，可以在不影响临床结果的情况下减少不同临床环境中抗生素的使用。然而，可用的数据是异质的，最近的试验没有发现显着的好处。尽管如此，从这些试验中，我们还是了解到了优化使用 PCT 的几个关键考虑因素，这取决于临床环境、表现的严重程度和细菌感染的预检概率。对于呼吸道感染和脓毒症患者，PCT 可用于确定是否在低风险环境中开始抗菌治疗，并结合临床数据确定是否在某些高风险环境中停止抗菌治疗。也有越来越多的证据表明 PCT 指导治疗 2019 年冠状病毒病 (COVID-19) 患者。本综述提供了 PCT 在不同临床环境和疾病中使用的最新概述，包括讨论其改善 COVID-19 患者护理的潜力。PCT 可用于确定是否在低风险环境中开始抗菌治疗，以及与临床数据一起确定是否在某些高风险环境中停止抗菌治疗。也有越来越多的证据表明 PCT 指导治疗 2019 年冠状病毒病 (COVID-19) 患者。本综述提供了 PCT 在不同临床环境和疾病中使用的最新概述，包括讨论其改善 COVID-19 患者护理的潜力。PCT 可用于确定是否在低风险环境中开始抗菌治疗，以及与临床数据一起确定是否在某些高风险环境中停止抗菌治疗。也有越来越多的证据表明 PCT 指导治疗 2019 年冠状病毒病 (COVID-19) 患者。本综述提供了 PCT 在不同临床环境和疾病中使用的最新概述，包括讨论其改善 COVID-19 患者护理的潜力。