Chest
Recent Advances in Chest MedicineRole of Procalcitonin in Managing Adult Patients With Respiratory Tract Infections
Section snippets
PCT for the Diagnosis of Respiratory Infections
Identifying a true “gold standard” for the diagnosis of respiratory infections is often problematic. The use of blood and sputum cultures have significant limitations25, 26 because of the duration of time required to obtain positive cultures and issues of colonization and contamination. Additionally, the inability to grow certain bacteria in standard cultures, as evidenced by the fact that causative microorganisms can be detected in only 10% to 20% of patients with respiratory infections,
PCT for Prognostication in Respiratory Infections
Accurate assessment of disease severity and predictions regarding a patient's clinical course assist patients, families, and caregivers with setting appropriate expectations regarding the illness. These assessments and predictions are also prerequisites for the adequate allocation of health-care resources and therapeutic options in the management of respiratory infections.9 This includes decisions regarding the need for regular hospital or ICU admission, diagnostic evaluation, and assessment
PCT for Therapeutic Decision About Initiation and Duration of Antibiotics
Although timely use of antibiotics is the most effective measure of preventing mortality and morbidity from bacterial respiratory infections, overuse of antibiotics causes considerable harm by exposing individual patients to adverse events including Clostridium difficile infection, by increasing the development of bacterial resistance, and by generating high costs.7, 8 Because of the limitations of traditional signs and symptoms in differentiating viral from bacterial disease, overuse of
Implementation of PCT In the Work-up of Patients With Respiratory Infections
Although further study of PCT in respiratory infections is warranted, it seems reasonable to begin using it clinically, based on the more robust areas of data summarized here. As previously reported, a number of protocols using PCT measurements can now be recommended that consider both clinical severity (based on patient characteristics or level of acuity of care site) and clinical entity (ie, which type of respiratory infection is being considered) to help physicians consider questions of
Costs and Cost-Effectiveness
An important consideration when using a new diagnostic test is the cost associated with the test with respect to the potential for producing a cost saving (the current cost of a PCT test in the United States varies from about $25 to $30). A recent meta-analysis concluded that PCT in the critical care setting may be cost effective because of the high antibiotic costs in critically ill patients.70 Although the same may not necessarily be true for general hospital inpatients with less expensive
Conclusions and Future Directions
It is clear that the use of PCT is not a stand-alone test and will not replace clinical intuition or thorough clinical evaluations of patients.77 PCT needs to be interpreted within the context of the clinical setting and the patient's situation because the correct understanding of PCT levels is predicated on the physician's pretest probability. In this way, it is similar to other markers such as the cardiac troponin or D-dimer. If PCT is embedded in clinical protocols adapted to the type of
Acknowledgments
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Schuetz was supported by a research grant from the Swiss Foundation for Grants in Biology and Medicine (Schweizerische Stiftung für medizinisch-biologisc Stipendien, PASMP3-127684/1) and received support from BRAHMS Inc and bioMerieux to attend meetings and fulfill speaking engagements. Dr Amin has received support from bioMerieux for speaking engagements. Dr Greenwald has reported
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