Procalcitonin Testing Improves Antibiotic Stewardship

Using procalcitonin testing results to guide antibiotic decisionmaking is associated with lower rates of antibiotic use, fewer antibiotic-related adverse effects, and improved overall survival, according to a clinical evidence synopsis published March 6 in the Journal of the American Medical Association.

Procalcitonin is expressed in response to bacterial infections and can be used as a marker of bacterial infection. February 2017, the U.S. Food and Drug Administration (FDA) approved procalcitonin to guide antibiotic decisionmaking for patients with respiratory tract infections who were either hospitalized or treated in the emergency department.

The study included a total of 26 randomized clinical trials published between 2004 and 2016. The studies represented 6,708 patients (men, 57 percent) internationally with acute infections of the upper or lower respiratory tract, including community-acquired pneumonia, exacerbation of chronic obstructive pulmonary disease due to infections, bronchitis, ventilator-associated pneumonia, hospital-acquired pneumonia, and upper respiratory infection.

The researchers found that procalcitonin testing was associated with a shorter duration of antibiotic exposure (-2 days), mean shorter duration of infection (-2.4 days), a 25 percent reduction in antibiotic-related adverse effects, and 17 percent lower 30-day mortality. These results were similar across types of respiratory infections and across clinical settings (e.g., emergency department, medical ward, or intensive care).

"Currently, the procalcitonin test is only approved by the FDA for use in the hospital or emergency department and further research is needed in primary care using rapid turnaround point-of-care procalcitonin tests," write the authors led by Philipp Schuetz, M.D., from University of Basel in Switzerland.

Takeaway: Procalcitonin testing is effective in guiding antibiotic stewardship and improving outcomes among patients with respiratory tract infections. Further research is needed to assess whether rapid procalcitonin tests are as effective in outpatient settings.