Harvard School of Public Health, MA, USA.
Expert Rev Anti Infect Ther. 2010 May;8(5):575-87. doi: 10.1586/eri.10.25.
Procalcitonin is a surrogate biomarker for estimating the likelihood of a bacterial infection. Procalcitonin-guided initiation and termination of antibiotic therapy is a novel approach utilized to reduce antibiotic overuse. This is essential to decrease the risk of side effects and emerging bacterial multiresistance. Interpretation of procalcitonin levels must always comprise the clinical setting and knowledge about assay characteristics. Only highly sensitive procalcitonin assays should be used in clinical practice and cut-off ranges must be adapted to the disease and setting. Highly sensitive procalcitonin measurements, embedded in diagnosis-specific clinical algorithms, have been shown to markedly reduce the overuse of antibiotic therapy without increasing risk to patients in 11 randomized controlled trials including over 3500 patients from different European countries. In primary care and emergency department patients with mild and mostly viral respiratory infections (acute bronchitis), the initial prescription of antibiotics was reduced by 30-80%. In hospitalized and more severely ill patients with community-acquired pneumonia and sepsis, the main effect was a reduction of the duration of antibiotic courses by 25-65%. This review aims to provide physicians with an overview of the strengths and limitations of procalcitonin guidance for antibiotic therapy when used in different clinical settings and in patients with different underlying infections.
降钙素原是一种用于评估细菌感染可能性的替代生物标志物。降钙素原指导抗生素治疗的开始和终止是一种新的方法，用于减少抗生素的过度使用。这对于降低副作用和出现细菌多重耐药的风险至关重要。降钙素原水平的解读必须始终包括临床情况和对检测特性的了解。只有在临床实践中使用高度敏感的降钙素原检测，并且必须根据疾病和情况来调整临界值范围。在包括来自不同欧洲国家的 3500 多名患者在内的 11 项随机对照试验中，已证明将降钙素原的高度敏感测量值嵌入特定于诊断的临床算法中，可以显著减少抗生素治疗的过度使用，而不会增加患者的风险。在初级保健和急诊科患有轻度且多为病毒性呼吸道感染（急性支气管炎）的患者中，抗生素的初始处方减少了 30-80%。在患有社区获得性肺炎和败血症的住院和病情更严重的患者中，主要效果是抗生素疗程缩短了 25-65%。这篇综述旨在为医生提供在不同临床环境中和患有不同潜在感染的患者中使用降钙素原指导抗生素治疗的优缺点概述。
