%0 Journal Article
%T Pro/Con debate: Is procalcitonin useful for guiding antibiotic decision making in critically ill patients?
%A Yahya Shehabi
%A Ian Seppelt
%J Critical Care
%D 2008
%I BioMed Central
%R 10.1186/cc6860
%X More than 40% of the patients in European and Australasian intensive care units (ICUs) have sepsis or severe sepsis, but only 58% of clinically suspected infections are confirmed by positive culture [1]. While it is perfectly justifiable to commence broad-spectrum antibiotics early, the decision to continue or cease such therapy remains an arbitrary one by the treating intensivist. This can lead to the indiscriminate overuse of antimicrobials, with significant cost implications and (of far greater concern) increasingly frequent outbreaks of resistant organisms [2].While fever, leukocytosis, and other responses to systemic inflammation are clinical signs consistent with sepsis and infection [3], they are neither specific nor sensitive to guide antibiotic therapy at any stage during sepsis management. A useful biomarker for sepsis must be Specific (as well as Sensitive), Measurable with a high degree of precision, readily Available (and Affordable), Responsive and Reproducible, with results available in a Timely fashion to guide therapy (SMART).More specifically, a useful sepsis biomarker should do the following [4]: (a) add value to the clinical evaluation, (b) shorten the time to definitive diagnosis, and (c) differentiate infectious and bacterial from noninfectious or nonbacterial causes. The utility of a biomarker is enhanced if it reflects (i) the severity of infection and the septic process and (ii) the effectiveness of therapy, including antibiotics, earlier and more accurately than clinical convention.Procalcitonin (PCT) normally has a plasma level of less than 0.1 ¦Ìg/L (ng/mL) in healthy subjects. Levels rise substantially in response to triggers released during bacterial and systemic infections, in particular endotoxin and inflammatory cytokines. The elimination half-life of PCT is between 22 and 35 hours. Whereas endotoxin and most other inflammatory cytokines (tumor necrosis factor-alpha and interleukin [IL]-1) are undetectable within 24 hours of an endoto
%U http://ccforum.com/content/12/3/211