Procalcitonin – A Way to a Better Antibiotic Stewardship in the Adult Population: A Literature Review
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Procalcitonin (PCT) is a relatively new diagnostic test in the United States. PCT results have been useful in early identification of severe bacterial infections, and differentiating systemic inflammatory response syndrome (SIRS) from sepsis. PCT was approved by the Federal Drug and Administration (FDA) in 2008, as an adjunct test to physical assessments and laboratory findings. PCT may be used concomitantly with C-reactive protein (CRP), blood culture, complete blood count (CBC), or cerebrospinal fluid (CSF) analysis, to assist in detecting progression to sepsis and septic shock in critically-ill patients. PCT is typically ordered upon initial presentation in a patient with signs and symptoms of systemic infection, such as fever of unknown origin, chills, tachycardia, tachypnea, confusion, and decreased urinary output. Low PCT (<2ng/L) signifies that the patient’s symptoms are caused by a process or agent other than bacteria and points to an early localized infection that has not yet spread systemically, or to a minor systemic inflammatory response. High levels of PCT (> 2 ng/L) indicate sepsis, with a greater likelihood of progression to septic shock if left untreated. Although not FDA approved for such use, decreasing serial PCT levels have been documented with successful antibiotic therapy. This literature review was conducted to evaluate PCT testing and its future as a gold standard in practitioners' efforts to combat antibiotic resistance and improve antibiotic stewardship.