The Utility of Procalcitonin as a Biomarker to Limit the Duration of Antibiotic Therapy in Adult Sepsis Patients

摘要: Introduction: With rising global antibiotic resistance, stewardship programs aimed at controlling multi-drug resistant (MDR) pathogens have begun to gain acceptance. These stress appropriate antibiotic selection, dosage and duration. A growing literature suggests serum procalcitonin (PCT) levels may be useful in guiding duration and de-escalation. This report sought evaluate the evidence-based data available from prospective randomized controlled trials (RCT) on role of PCT guiding reductions adult sepsis patients. Methods: A comprehensive search all published RCT(s) use as a tool for therapy patients was conducted using PubMed, Medline Plus Google Scholar (2007-2013). Keywords searched included, “procalcitonin”, “sepsis-therapy”, “sepsis biomarker”, “antibiotic duration”, “drug de-escalation”, “antimicrobial stewardship”. Results: Four involving 826 sepsis patients have evaluated serum guide criteria for cessation based either specific or PCT kinetics. Bouadma et al. (N = 621) stopped antibiotics when PCT concentration  et 27) discontinued if clinical signs infection improved value decreased 110) ceased PCT decreased 1 ng/mL. The arm showed a 2-day reduction in antibiotics. Finally, Nobre et 68) PCT levels by 90% more from initial value, but not prior Day 3 (if baseline measured p