Procalcitonin-guided antibiotic therapy: an expert consensus

Current clinical practice lacks standardized guidance for using procalcitonin in managing infections. While prior research has shown that procalcitonin can help identify bacterial infections, its role in different clinical settings remains unclear. No prior work had resolved how to apply procalcitonin consistently across emergency departments, wards, and intensive care units. That uncertainty drove the need for expert consensus on its use. It was already known that procalcitonin levels correlate with bacterial infection severity, but how to interpret these levels in real-world scenarios was not well defined. This gap motivated the development of evidence-based recommendations. The challenge lies in balancing the benefits of procalcitonin with the risks of misinterpretation. No single study had provided a comprehensive framework for integrating procalcitonin into clinical workflows.

The goal was to create a consensus on the appropriate use of procalcitonin in managing infections. Experts aimed to clarify when and how to use procalcitonin in different clinical settings. They wanted to address the variability in current practices and reduce unnecessary antibiotic use. The focus was on improving antimicrobial stewardship in critical care. They examined whether procalcitonin could guide decisions about starting, stopping, or changing antibiotics. The study also aimed to define the limitations of procalcitonin in guiding therapy. They considered how to integrate procalcitonin with other clinical assessments. The ultimate aim was to provide a practical framework for clinicians to follow.

A group of 14 experts from multiple medical fields participated in a modified Delphi process. They reviewed the literature and provided their opinions through three rounds of discussion. Each round aimed to refine the consensus on procalcitonin use. They evaluated the appropriateness of using procalcitonin for diagnosis, prognosis, and antimicrobial stewardship. The process included scenarios such as emergency departments, surgical wards, and intensive care units. They assessed when and how to measure procalcitonin in different settings. The experts considered the limitations of relying solely on procalcitonin for clinical decisions. They emphasized the need for high-sensitivity assays and proper interpretation of results.

The experts agreed that procalcitonin is appropriate for antibiotic de-escalation and discontinuation. They found that high-sensitivity assays are necessary for reliable results. Procalcitonin should not be used alone to start or increase antibiotic therapy in acute respiratory infections. Clinical and radiological findings must also be considered. The timing of procalcitonin measurement varies depending on the clinical scenario. The consensus emphasized the importance of patient-specific factors in interpreting results. They proposed that procalcitonin should guide decisions in the intensive care unit and emergency departments. The study found that procalcitonin use can reduce unnecessary antibiotic exposure.

The authors propose that procalcitonin should be used in algorithms for antibiotic de-escalation. They suggest that high-sensitivity assays are essential for accurate results. Procalcitonin should not replace clinical judgment in initiating antibiotic therapy. The consensus supports using procalcitonin in intensive care and emergency settings. They recommend integrating procalcitonin with other clinical assessments. The authors propose that procalcitonin can help reduce antibiotic overuse. They suggest that the timing of measurements should align with clinical needs. The findings support the use of procalcitonin as part of a broader antimicrobial stewardship strategy.