Choosing Wisely:

Don’t perform procalcitonin testing without an established, evidence-based protocol.

Rationale and Comments: Procalcitonin is a biomarker that has been used successfully to identify patients with certain bacterial infections (e.g., sepsis). The appropriate use includes serial (usually daily) measurements of procalcitonin in select patient populations (e.g., patients with fever and presumed serious infection for which antibiotics were initiated). Such uses may help to identify low-risk patients with respiratory infections who would not benefit from antibiotic therapy, and to differentiate blood culture contaminants (e.g., coagulase-negative staphylococci) from true infections. When used appropriately, there are significant opportunities to decrease unnecessary antimicrobial use. The overuse of antimicrobial agents is directly related to the increasing antimicrobial resistance, so judicious use of these agents is warranted. Unfortunately, procalcitonin is often either misused (i.e., not used in the appropriate setting) or established algorithms are not followed. When the latter occurs, the procalcitonin result becomes simply another piece of laboratory data that adds costs, but does not benefit the patient. These scenarios often occur because there is not an evidence-based utilization plan established at an institution. Laboratory and intensive care unit leadership are encouraged to identify the major users of procalcitonin, to establish guidelines that are most appropriate for the local setting and to monitor use.
Sponsoring Organizations:
  • American Society for Clinical Pathology
  • Sources:
  • Randomized controlled trials
  • Disciplines:
  • Infectious disease
  • References: • Assink-de Jong E. de Lange DW van Oers JA, et al. Stop Antibiotics on guidance of Procalcitonin Study (SAPS): a randomized prospective multicenter investigator-initiated trial to analyse whether daily measurements of procalcitonin versus standard-of-care approach can safely shorten antibiotic duration in intensive care unit patients – calculated sample size: 1816 patients. BMC Infectious Diseases. 2013:13:178.
    • Rhee C. Using Procalcitonin to Guide Antibiotic Therapy. Open Forum Infect Dis. 2017:4:ofw249.
    • Bouadma L, Luyt CE, Tubach F, et al. Use of Procalcitonin to Reduce Patients’ Exposure to Antibiotics in Intensive Care Units (PRORATA Trial): a Multicentre Randomised Controlled Trial. Lancet. 2010;375:463-74. 24 25.

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