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Rigshospitalet - a part of Copenhagen University Hospital
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Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

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  • Philipp Schuetz
  • Albertus Beishuizen
  • Michael Broyles
  • Ricard Ferrer
  • Gaetan Gavazzi
  • Eric Howard Gluck
  • Juan González Del Castillo
  • Peter Laszlo Kanizsai
  • Andrea Lay Hoon Kwa
  • Stefan Krueger
  • Charles-Edouard Luyt
  • Michael Oppert
  • Mario Plebani
  • Sergey A Shlyapnikov
  • Giulio Toccafondi
  • Jennifer Townsend
  • Tobias Welte
  • Kordo Saeed
  • Jens Ulrik Stæhr Jensen
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Background Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. Results The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the fixed cut-offs to only one for mild to moderate and one for severe disease (0.25 μg/L and 0.5 μg/L, respectively). Further, guidance on interpretation of PCT results to initiate, withhold or discontinue ABx treatment was included. Conclusions A combination of clinical patient assessment with PCT levels in well-defined ABS algorithms, in context with continuous education and regular feedback to all ABS stakeholders, has the potential to improve the diagnostic and therapeutic management of patients suspected of bacterial infection, thereby improving ABS effectiveness.

Original languageEnglish
JournalClinical Chemistry and Laboratory Medicine
Volume57
Issue number9
Pages (from-to)1308-1318
Number of pages11
ISSN1434-6621
DOIs
Publication statusPublished - 27 Aug 2019

    Research areas

  • Adult, Algorithms, Anti-Bacterial Agents/therapeutic use, Antimicrobial Stewardship/methods, Bacterial Infections/diagnosis, Biomarkers/blood, Calcitonin/therapeutic use, Consensus, Female, Humans, Male, Middle Aged, Procalcitonin/metabolism, Sepsis/diagnosis

ID: 61232979