Abstract

Background

Procalcitonin (PCT) is a new biomarker with a higher accuracy in the diagnosis of bacterial infections. Utilization of PCT may reduce the number of unnecessary antibiotics prescribed to patients, and consequently may decrease the rise in antibiotic resistance.

The aim of this systematic review is to determine if a PCT-guided algorithm can safely reduce the number of antibiotics prescribed to all patients with a suspected of infection in the emergency department(ED).

Methods

MEDLINE, EMBASE, Web-of-science, COCHRANE central, PubMed publisher and Google scholar were searched. Two reviewers performed the screening independently. The QUADAS 2 tool was used to assess quality.

Results

In total, 1621 articles were screened. Nine articles were included in the analysis. In the six studies on adult patients, only patients with respiratory tract infections were investigated. In these studies, a cut-off value of 0.25mcg/L was used, and PCT-guided therapy reduced the number of prescribed antibiotics significantly. Three studies were on pediatric patients, two on fever without source, and one on respiratory complaints. PCT-guided therapy did not reduce antibiotic prescription in children. PCT-guided therapy did not result in an increase in adverse events in any of the studies.

Discussion

PCT-guided therapy in the ED is only studied in subpopulations, where it was effective and safe in adult patients with respiratory tract infections, and not effective but safe nonetheless in specific pediatric populations. Nonadherence is a significant problem in prospective PCT-guided therapy studies. There is not enough evidence to use PCT-guided therapy in a general ED population.