The Utility of Procalcitonin as a Biomarker to Limit the Duration of Antibiotic Therapy in Adult Sepsis Patients

Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. In the modern antibiotic era, treatment protocols for sepsis necessitate the rapid institution of broad-spectrum antibiotics.

Pocalcitonin (PCT) is a biomarker with unique properties that make it a potential serum marker for directing the clinical management of sepsis. A growing literature on procalcitonin suggests significant potential for its use in the diagnosis of sepsis, although its role in clinical medicine continues to be controversial. This report sought to evaluate the evidence-based data available from prospective randomized controlled trials (RCT) on the role of PCT in guiding reductions in antibiotic duration in adult sepsis patients.

A comprehensive search of published prospective RCT(s) on the use of PCT as a tool for guiding antibiotic therapy in adult sepsis patients was conducted using PubMed, Medline Plus and Google Scholar (2007-2013). Keywords searched included, “procalcitonin”, “sepsis-therapy”, “sepsis biomarker”, “antibiotic duration”, “drug de-escalation”, and “antimicrobial stewardship”. Finally, four prospective randomized studies evaluating the utility of PCT serums levels in reducing antibiotic duration have been found, of which all report beneficial outcomes. All four studies utilized a similar design, in which a “PCT-directed intervention arm” was compared with a “standard of care arm”. And the studies shared several common endpoints, specifically the reduction of antibiotic therapy duration (in days) and patient mortality, though each study utilized different criteria in determining the optimal timeframe for antibiotic discontinuation.

In summary, PCT-guided early cessation of antibiotic therapy in adult sepsis patients is associated with a significant decrease in antibiotic days, without any change in overall mortality. Given the success of these trials, PCT may find a place in antimicrobial stewardship programs aimed at limiting antibiotic therapy duration while decelerating the development of antibiotic resistance.

Article by Ronald S. Chamberlain, et al, from USA and West Indies.

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