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Recent Advances in Chest Medicine |

Role of Procalcitonin in Managing Adult Patients With Respiratory Tract InfectionsProcalcitonin for Managing Respiratory Infections

Philipp Schuetz, MD, MPH; Devendra N. Amin, MD, FCCP; Jeffrey L. Greenwald, MD
Author and Funding Information

From the Harvard School of Public Health (Dr Schuetz); Inpatient Clinician Educator Service (Dr Greenwald), the Department of Medicine, Massachusetts General Hospital, Boston, MA; and Medical/Surgical ICU (Dr Amin), Morton Plant Hospital, Clearwater, FL.

Correspondence to: Philipp Schuetz, MD, MPH, Harvard School of Public Health, 667 Huntington Ave, Boston, MA 02115; e-mail: Schuetzph@gmail.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Funding/Support: The authors have reported to CHEST that no funding was received for this study.


© 2012 American College of Chest Physicians


Chest. 2012;141(4):1063-1073. doi:10.1378/chest.11-2430
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Respiratory infections remain the most common reason why patients seek medical care in ambulatory and hospital settings, and they are the most frequent precursor of sepsis. In light of the limitations of clinical signs and symptoms and traditional microbiologic diagnostics for respiratory infections, blood biomarkers that correlate with the presence and extent of bacterial infections may provide additional useful information to improve diagnostic and prognostic efforts and help with therapeutic decisions in individual patients. A growing body of evidence supports the use of procalcitonin (PCT) to differentiate bacterial from viral respiratory diagnoses, to help risk stratify patients, and to guide antibiotic therapy decisions about initial need for, and optimal duration of, therapy. Although still relatively new on the clinical frontier, a series of randomized controlled trials have evaluated PCT protocols for antibiotic-related decision making and have included patients from different clinical settings and with different severities of respiratory infection. In these trials, initial PCT levels were effective in guiding decisions about the initiation of antibiotic therapy in lower-acuity patients, and subsequent measurements were effective for guiding duration of therapy in higher-acuity patients, without apparent harmful effects. Recent European respiratory infection guidelines now also recognize this concept. As with any other laboratory test, PCT should not be used on a stand-alone basis. Rather, it must be integrated into clinical protocols, together with clinical, microbiologic data and with results from clinical risk scores. The aim of this review is to summarize recent evidence about the usefulness of PCT in patients with lower respiratory tract infections and to discuss the potential benefits and limitations of this marker when used for clinical decision making.

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