Universität zu Köln

Hohn, Andreas, Heising, Bernhard, Schuette, Jan-Karl, Schroeder, Olaf and Schroeder, Stefan (2017). Procalcitonin-guided antibiotic treatment in critically ill patients. Langenbecks Arch. Surg., 402 (1). S. 1 - 14. NEW YORK: SPRINGER. ISSN 1435-2451

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Abstract

In critically ill patients, length of antibiotic treatment can be effectively guided by procalcitonin (PCT) protocols. International sepsis guidelines and guidelines on antibiotic stewardship strategies recommend PCT as helpful laboratory marker for a rational use of antibiotics. A number of studies and meta-analyses have confirmed the effectiveness of PCT-protocols for shortening antibiotic treatment without compromising clinical outcome in critically ill patients. But in clinical practice, there is still uncertainty how to interpret PCT levels and how to adjust antibiotic treatment in various infectious situations, especially in the perioperative period. This narrative review gives an overview on the application of PCT-protocols in critically ill patients with severe bacterial infections on the basis of 5 case reports and the available literature. Beside strengths and limitations of this biomarker, also varying kinetics and different maximum values with regard to the infectious focus and pathogens are discussed. PCT-guided antibiotic treatment appears to be safe and effective. Most of the studies revealed a shorter antibiotic treatment without negative clinical outcomes. Cost effectiveness is still a matter of debate and effects on bacterial resistance due to shorter treatments, possible lower rates of drug-related adverse events, or decreased rates of Clostridium difficile infections are not yet evaluated. Guidance of antibiotic treatment can effectively be supported by PCT-protocols. However, it is important to consider the limitations of this biomarker and to use PCT protocols along with antibiotic stewardship programmes and regular clinical rounds together with infectious diseases specialists.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hohn, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Heising, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Schuette, Jan-Karl UNSPECIFIED UNSPECIFIED UNSPECIFIED Schroeder, Olaf UNSPECIFIED UNSPECIFIED UNSPECIFIED Schroeder, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-240984
DOI:	10.1007/s00423-016-1458-4
Journal or Publication Title:	Langenbecks Arch. Surg.
Volume:	402
Number:	1
Page Range:	S. 1 - 14
Date:	2017
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1435-2451
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RESPIRATORY-TRACT INFECTIONS; INTENSIVE-CARE PATIENTS; SEPTIC PATIENTS; SEVERE SEPSIS; ANTIMICROBIAL THERAPY; PLASMA-CONCENTRATIONS; ALGORITHMS; GUIDELINES; DIAGNOSIS; METAANALYSIS Multiple languages Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/24098