SUNY Upstate University Hospital, Syracuse, NY 13210, USA.
Am J Health Syst Pharm. 2012 Dec 1;69(23):2057-61. doi: 10.2146/ajhp110736.
The role of procalcitonin in guiding antibiotic therapy is reviewed.
Procalcitonin is a prohormone for calcitonin, which is secreted by the parafollicular cells of the thyroid gland. The biological activity of procalcitonin is significantly different from calcitonin and is believed to be part of the complex inflammatory cascade of the immune system. Procalcitonin has been shown to be elevated in bacterial infections but not in viral infections or other inflammatory conditions. The first published study that suggested that procalcitonin levels increased in the presence of bacterial infection was conducted in France in the early 1990s. Numerous studies have been conducted using procalcitonin-guided therapy to reduce antibiotic use. These studies were performed in one of three clinical settings: outpatient primary care (two multicenter, noninferiority studies of patients with upper- and lower-respiratory-tract infections), emergency room and inpatient (five studies in patients with chronic obstructive pulmonary disease, exacerbation, bronchitis, or community-acquired pneumonia), and the intensive care unit (ICU) (two studies in medical ICU patients and two in postoperative ICU patients with infection or sepsis). Based on the findings of these studies, a cutoff value of 0.25 μg/L in non-ICU patients or of 0.5 μg/L in ICU patients seems appropriate for making a decision about the initiation and discontinuation of antibiotic therapy. In patients with a significantly elevated baseline procalcitonin level, a subsequent drop of >80% appears to be reasonable for discontinuing antibiotics.
Published evidence supports the use of procalcitonin as a biomarker of bacterial infection that can be used to reduce antibiotic exposure.
综述降钙素原在指导抗生素治疗中的作用。
降钙素原是降钙素的前体激素，由甲状腺滤泡旁细胞分泌。降钙素原的生物学活性与降钙素显著不同，被认为是免疫系统复杂炎症级联反应的一部分。降钙素原已被证明在细菌感染时升高，但在病毒感染或其他炎症情况下不会升高。最早表明降钙素原水平在细菌感染存在时升高的研究是在 20 世纪 90 年代初在法国进行的。许多研究已经使用降钙素原指导治疗来减少抗生素的使用。这些研究在三种临床环境中进行：门诊初级保健（两项针对上下呼吸道感染患者的多中心非劣效性研究）、急诊室和住院部（五项针对慢性阻塞性肺疾病、加重、支气管炎或社区获得性肺炎患者的研究）和重症监护病房（ICU）（两项针对 ICU 内科患者和两项针对感染或败血症的术后 ICU 患者的研究）。基于这些研究的结果，对于决定开始和停止抗生素治疗，非 ICU 患者的截断值为 0.25μg/L，ICU 患者的截断值为 0.5μg/L 似乎是合适的。对于基线降钙素原水平显著升高的患者，随后下降>80%似乎是停止使用抗生素的合理标准。
已有证据支持使用降钙素原作为细菌感染的生物标志物，以减少抗生素暴露。
