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Semin Respir Crit Care Med 2011; 32(2): 181-187
DOI: 10.1055/s-0031-1275530
© Thieme Medical Publishers

Value of the Serum Procalcitonin Level to Guide Antimicrobial Therapy for Patients with Ventilator-Associated Pneumonia

Charles-Edouard Luyt1 , 2 , Alain Combes1 , 2 , Jean-Louis Trouillet1 , 2 , Jean Chastre1 , 2
  • 1Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié–Salpêtrière, Paris, France
  • 2Université Paris 6–Pierre et Marie Curie, Paris, France
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Publication History

Publication Date:
19 April 2011 (online)

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ABSTRACT

Procalcitonin's contribution to the diagnosis of nosocomial infection, particularly ventilator-associated pneumonia (VAP), is poor: its levels in patients with microbiologically documented VAP the day infection is diagnosed range from normal to extremely high. Moreover, the results of four studies showed that, despite relatively good specificity, this marker had low sensitivity for the diagnosis of VAP. However, because procalcitonin is well associated with outcome, its kinetics during antimicrobial therapy can be used to customize that treatment duration. Two recent studies showed that a procalcitonin-based strategy (recommending that treating physicians stop antibiotics when the procalcitonin concentration was <0.5 ng/mL, or had decreased by ≥80%) led to less antibiotic consumption by VAP patients, compared with a conventional strategy, with no adverse outcome. Accordingly, for VAP patients, procalcitonin may be used to stop antibiotics as early as day 3 after their initiation, if its concentration is <0.5 ng/mL or has decreased by ≥80%, compared with the first peak concentration.

KEYWORDS

Procalcitonin - ventilator-associated pneumonia - nosocomial infection - antibiotics

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Charles-Edouard LuytM.D. Ph.D. 

Service de Réanimation Médicale, Institut de Cardiologie, Groupe Hospitalier Pitié–Salpêtrière

47–83, boulevard de l'Hôpital, 75651 Paris Cedex 13, France

Email: charles-edouard.luyt@psl.aphp.fr