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Decrease in serum procalcitonin levels over time during treatment of acute bacterial meningitis

Alain Viallon1, Pantéa Guyomarc'h, Stéphane Guyomarc'h

  • 1Emergency and Intensive Care Units, Bellevue Hospital, Saint-Etienne, France. alain.viallon@chu-st-etienne.fr

Critical Care (London, England)
|September 3, 2005
PubMed
Abstract

Insights

Serum procalcitonin levels rapidly decrease with effective antibiotic treatment for bacterial meningitis. This rapid decline suggests lumbar puncture may be less valuable for assessing treatment efficacy 48-72 hours post-admission.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Biomarkers

Background:

  • Community-acquired acute bacterial meningitis is a serious infection requiring prompt diagnosis and treatment.
  • Serum procalcitonin is a biomarker used to guide antibiotic therapy in bacterial infections.

Purpose of the Study:

  • To characterize the dynamic changes in serum procalcitonin (PCT) levels during the treatment of community-acquired acute bacterial meningitis.
  • To evaluate the utility of PCT as a marker for treatment response in this patient population.

Main Methods:

  • A cohort of 48 patients with confirmed bacterial meningitis and elevated admission serum PCT levels (>0.5 ng/ml) were prospectively studied.
  • Serum PCT and C-reactive protein (CRP) levels were measured on admission and at day 2 of antibiotic treatment.
  • Causative bacterial pathogens were identified, and treatment efficacy was assessed clinically and by cerebrospinal fluid sterilization.

Main Results:

  • A significant decrease in median serum PCT levels was observed from 4.5 (interquartile range [IQR] 2.8-10.8) mg/ml on admission to 2 (IQR 0.9-5.0) mg/ml on day 2 (P < 0.0001).
  • In contrast, serum CRP levels showed a non-significant increase during the same period.
  • Cerebrospinal fluid sterilization was achieved in 34 patients by 48-72 hours, and all patients responded to initial antibiotic treatment.

Conclusions:

  • Serum procalcitonin levels demonstrate a rapid decline in response to appropriate antibiotic therapy for bacterial meningitis.
  • The rapid decrease in PCT levels may reduce the diagnostic value of lumbar puncture performed 48-72 hours after treatment initiation for assessing efficacy.
  • PCT monitoring offers a potentially faster method for evaluating treatment response compared to traditional methods.

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