Schuetz Philipp, Bretscher Celine, Bernasconi Luca, Mueller Beat
a Medical University Department , Kantonsspital Aarau - Endocrinology/Diabetes/Clinical Nutrition and Internal Medicine , Aarau , Switzerland.
b Departement Biomedizin , Universitat Basel , Basel , Switzerland.
Expert Rev Mol Diagn. 2017 Jun;17(6):593-601. doi: 10.1080/14737159.2017.1324299. Epub 2017 May 3.
Procalcitonin is a surrogate infection blood marker whose levels help estimate the likelihood of bacterial infections and correlate with their resolution. Recent trials have revealed the benefits of inclusion of procalcitonin in antibiotic stewardship protocols for initiation and discontinuation of antimicrobial therapy. Areas covered: Procalcitonin-guided antibiotic stewardship protocols have shown appreciable reductions in antibiotic use and duration of therapy in respiratory infections, sepsis, and other infections, with positive effects on clinical outcomes. Multiple fully automated and sensitive procalcitonin assays are routinely used in clinical practice. Utilization of these assays requires consideration of the clinical setting and knowledge of assay characteristics, particularly assay sensitivities, reproducibility, and performance across routinely used cut-off ranges. The authors provide an overview of the strengths and limitations of currently available procalcitonin assays and antibiotic therapy algorithms incorporating procalcitonin currently used in different clinical settings and in patients with different underlying infections. Expert commentary: Use of sensitive procalcitonin measurements in clinical algorithms can reduce antimicrobial overuse, decreasing the risk of side effects and controlling emerging bacterial multi-resistance. Before use in clinical practice, it is important to carefully assess the quality of novel PCT assays and rigorously evaluate them in target patient populations across clinically relevant cut-off ranges.
降钙素原是一种替代性感染血液标志物，其水平有助于评估细菌感染的可能性，并与感染的消退相关。最近的试验揭示了在抗生素管理方案中纳入降钙素原以启动和停止抗菌治疗的益处。涵盖领域：降钙素原指导的抗生素管理方案已显示，在呼吸道感染、脓毒症及其他感染中，抗生素使用量和治疗持续时间显著减少，对临床结局产生积极影响。临床实践中常规使用多种全自动且灵敏的降钙素原检测方法。使用这些检测方法需要考虑临床背景以及对检测特性的了解，特别是检测灵敏度、重复性以及在常规使用的临界值范围内的表现。作者概述了当前可用的降钙素原检测方法以及目前在不同临床背景和不同潜在感染患者中使用的纳入降钙素原的抗生素治疗算法的优势和局限性。专家评论：在临床算法中使用灵敏的降钙素原检测可减少抗菌药物的过度使用，降低副作用风险并控制新出现的细菌多重耐药性。在临床实践中使用之前，仔细评估新型降钙素原检测方法的质量并在目标患者群体中跨临床相关临界值范围进行严格评估非常重要。
