Procalcitonin - Assisted Antibiotic Strategy in Sepsis

Domonkos Trásy, Zsolt Molnár, Domonkos Trásy, Zsolt Molnár

Abstract

Sepsis is one of the biggest challenges in critical care nowadays. Defining sepsis is a difficult task on its own and its diagnosis and treatment requires well trained, devoted personnel with interdisciplinary collaboration in order to provide the patients the best chance for survival. Immediate resuscitation, early adequate antimicrobial therapy, source control and highly sophisticated organ support on the intensive care units are all inevitable necessities for successful recovery. To help fast and accurate diagnosis biomarkers have been measured for decades. Procalcitonin (PCT) is one of the most studied, but the results are conflicting. Sepsis means a very loose cohort of a large heterogeneous patient population, hence defining certain cut off values for PCT to differentiate between different severities of the disease is almost impossible. Clinicians first have to understand the pathophysiological background of sepsis to be able to interpret correctly the PCT results. Nevertheless, PCT has been shown to have the best sensitivity and specificity to indicate infection, antibiotic appropriateness and stopping therapy. In this article we will focus on some important aspects of pathophysiology and advice on how to implement that in the everyday clinical practice. We believe that this multimodal evaluation of the clinical picture together with PCT results can be a useful tool to make the most out of the PCT results, and do the best for patients on the ICU.

Keywords: antibiotic; biomarkers; procalcitonin; sepsis; septic shock.

Conflict of interest statement

Author’s disclosures: Zsolt Molnar receives lecture honoraria from ThermoFisher Scientific.

Figures

Figure 1
Figure 1
The molecular responses for damage (DAMP) and pathogen (PAMP) type insults
Figure 2
Figure 2
PCT kinetics during the first day of effective and ineffective empiric antibiotic therapy [24]

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Source: PubMed

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