Samford University McWhorter School of Pharmacy, Birmingham, Alabama.
Pharmacotherapy. 2018 May;38(5):569-581. doi: 10.1002/phar.2112. Epub 2018 Apr 23.
Effective antimicrobial stewardship practices are increasingly essential to best utilize the current arsenal of antimicrobials for the shortest necessary duration to minimize the development of antimicrobial resistance, secondary infections, and health care costs. Monitoring of serum procalcitonin (PCT) levels represents an effective antimicrobial stewardship strategy to differentiate bacterial infections from viral infections and noninfectious inflammatory conditions. Current literature illustrates the merits of PCT monitoring in reducing duration of antibiotic therapy without detrimental effects on mortality or infection relapses. However, the interpretation of PCT levels can be challenging, especially in light of comorbid disease states that can elevate PCT levels. This review sheds light on the utility of PCT monitoring, as well as providing insight into the practical interpretation of PCT levels. Much of the current literature surrounding PCT monitoring consists of use among patients with lower respiratory tract infections or in the critically ill. Overall, studies have demonstrated shorter antibiotic therapy durations when PCT monitoring is utilized. No studies to date have found increased rates of mortality or infection relapses, suggesting that PCT monitoring is not only effective, but also safe when used as a guide for antimicrobial therapy. Nonetheless, many conditions were shown to elevate PCT serum concentrations, even in the absence of bacterial infections, which can make interpretation of PCT concentrations challenging. Two common conditions that affect the accurate interpretation of PCT levels are renal dysfunction and congestive heart failure. Limited studies have been performed in these populations, but current available data propose the need for higher PCT thresholds in those with renal dysfunction or congestive heart failure and support utilizing PCT trends to monitor clinical improvement from bacterial infections. Evidence also suggests that PCT monitoring is cost-effective, as long as the test is ordered judiciously. In summary, PCT monitoring represents a promising antimicrobial stewardship strategy to limit exposure to unnecessary antimicrobial therapy.
有效的抗菌药物管理实践对于最佳利用当前的抗菌药物储备至关重要，以最短的必要时间使用，最大限度地减少抗菌药物耐药性的发展、继发感染和医疗保健成本。监测血清降钙素原 (PCT) 水平是一种有效的抗菌药物管理策略，可以区分细菌感染、病毒感染和非感染性炎症性疾病。现有文献表明，PCT 监测可减少抗生素治疗时间，而不会对死亡率或感染复发产生不利影响。然而，PCT 水平的解读具有挑战性，尤其是在考虑到可能升高 PCT 水平的合并疾病状态时。本文综述了 PCT 监测的实用性，并提供了对 PCT 水平的实际解读的见解。目前围绕 PCT 监测的大部分文献都集中在患有下呼吸道感染或重症患者中的应用。总的来说，当使用 PCT 监测时，抗生素治疗时间更短。迄今为止，没有研究发现死亡率或感染复发率增加，这表明 PCT 监测不仅有效，而且在作为抗菌治疗的指导时也是安全的。尽管如此，许多疾病都会导致 PCT 血清浓度升高，即使没有细菌感染，这使得 PCT 浓度的解读具有挑战性。两种常见的影响 PCT 水平准确解读的疾病是肾功能不全和充血性心力衰竭。在这些人群中进行的研究有限，但现有数据表明，肾功能不全或充血性心力衰竭患者需要更高的 PCT 阈值，并支持使用 PCT 趋势来监测细菌感染的临床改善。证据还表明，只要明智地订购检测，PCT 监测就是一种具有成本效益的方法。总之，PCT 监测是一种有前途的抗菌药物管理策略，可以限制不必要的抗菌药物治疗的暴露。
