National Taiwan University Hospital, Emergency Medicine Department and Health Data Science Research Group, Taipei, Taiwan.
Singapore General Hospital, Singapore, Singapore.
Clin Chem Lab Med. 2020 Nov 26;58(12):1983-1991. doi: 10.1515/cclm-2019-1122.
Introduction Recently, an expert consensus on optimal use of procalcitonin (PCT)-guided antibiotic stewardship was published focusing mainly on Europe and the United States. However, for Asia-Pacific countries, recommendations may need adaptation due to differences in types of infections, available resources and standard of clinical care. Methods Practical experience with PCT-guided antibiotic stewardship was discussed among experts from different countries, reflecting on the applicability of the proposed Berlin consensus algorithms for Asia-Pacific. Using a Delphi process, the group reached consensus on two PCT algorithms for the critically ill and the non-critically ill patient populations. Results The group agreed that the existing evidence for PCT-guided antibiotic stewardship in patients with acute respiratory infections and sepsis is generally valid also for Asia-Pacific countries, in regard to proposed PCT cut-offs, emphasis on diagnosis, prognosis and antibiotic stewardship, overruling criteria and inevitable adaptations to clinical settings. However, the group noted an insufficient database on patients with tropical diseases currently limiting the clinical utility in these patients. Also, due to lower resource availabilities, biomarker levels may be measured less frequently and only when changes in treatment are highly likely. Conclusions Use of PCT to guide antibiotic stewardship in conjunction with continuous education and regular feedback to all stakeholders has high potential to improve the utilization of antibiotic treatment also in Asia-Pacific countries. However, there is need for adaptations of existing algorithms due to differences in types of infections and routine clinical care. Further research is needed to understand the optimal use of PCT in patients with tropical diseases.
简介
最近，发布了一份关于降钙素原（PCT）指导下抗生素管理的专家共识，主要聚焦于欧洲和美国。然而，对于亚太国家，由于感染类型、可用资源和临床护理标准的差异，建议可能需要进行调整。
方法
不同国家的专家对 PCT 指导下抗生素管理的实践经验进行了讨论，反思了拟议的柏林共识算法在亚太地区的适用性。通过德尔菲法，专家组就危重症和非危重症患者人群的两种 PCT 算法达成了共识。
结果
专家组一致认为，目前针对急性呼吸道感染和败血症患者的 PCT 指导下抗生素管理的证据，在建议的 PCT 截断值、强调诊断、预后和抗生素管理、否决标准以及对临床环境的不可避免的调整方面，对于亚太国家通常也是有效的。然而，专家组注意到，目前关于热带病患者的数据库不足，这限制了这些患者的临床应用。此外，由于资源可用性较低，生物标志物的测量可能较少，而且只有在治疗发生重大变化时才会进行测量。
结论
在亚太国家，结合持续教育和定期向所有利益相关者提供反馈，使用 PCT 来指导抗生素管理，具有很大的潜力来改善抗生素治疗的利用。然而，由于感染类型和常规临床护理的差异，需要对现有的算法进行调整。需要进一步研究以了解 PCT 在热带病患者中的最佳应用。
