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Table 1 Overview of studies investigating the use of procalcitonin in different types and sites of infections

From: Procalcitonin-guided diagnosis and antibiotic stewardship revisited

  Type of infection New studies since 2010? Study design PCT cut-off (μg/L) Benefit of PCT use? Main conclusions Selected references since 2012
Pulmonary AECOPD yes RCT (N = 120),
meta-analysis
<0.25 ++ PCT reduces initiation of antibiotic treatment in the ED without adverse outcomes [7, 12]
Asthma yes RCT (N = 216) <0.1–0.25 ++ PCT reduces initiation of antibiotic treatment in the ED without adverse outcomes [89]
Bronchitis yes (Registry) RCT, real-life (Registry) <0.1–0.25 ++ PCT reduces initiation of antibiotic treatment in the ED without adverse outcomes [42]
Community-acquired pneumonia yes RCT, meta-analysis (N = 4467)
real-life (Registry)
<0.1–0.25; 80–90% decrease +++ PCT shortens length of antibiotic therapy in the ED and hospital ward without adverse outcomes [7]
Pulmonary fibrosis yes RCT (N = 78) <0.25 ++ PCT reduces initiation of antibiotic treatment in the ED without adverse outcomes [15]
Upper respiratory tract infections no RCT (N = 458, 702) <0.1–0.25 +++ PCT reduces initiation of antibiotic treatment in primary care without adverse outcomes (non-inferiority) [90, 91]
Heart Congestive heart failure yes Observational, RCT (secondary analysis, N = 110) <0.21–0.25 ++ PCT helps in identification of bacterial superinfection in acute heart failure, may be helpful in guiding antibiotic treatment [38, 43]
Endocarditis no Observational, meta-analysis <0.5 + PCT is a predictor of poor outcome, diagnostic value similar to CRP [67, 68]
Abdominal Abdominal infections with peritonitis yes Observational <0.5; 80% decrease ++ PCT-guided therapy was associated with lower antibiotic exposure with no difference in mortality [66]
Appendicitis yes Observational, meta-analysis NR + PCT is a marker of complicated appendicitis, low value for diagnosing appendicitis [92]
Pancreatitis yes RCT (N = 71) <0.5 ++ PCT reduces antibiotic exposure compared to prophylactic antibiotic treatment without adverse outcomes [65]
Urinary tract infections yes RCT (N = 125) <0.25 ++ PCT reduces antibiotic exposure without adverse effects [47]
Blood Blood stream infection yes Observational <0.25–1.47 ++ PCT levels correlate with risk for positive blood cultures [19, 27]
Neutropenia yes RCT (N = 62) NR PCT is not useful to manage antibiotic therapy, but PCT was a marker of bacteremia [93]
Severe sepsis/shock yes RCT (N = 1575) <0.5; 80% decrease +++ PCT reduces antibiotic exposure and 3 month mortality in the ICU [30]
Postoperative Postoperative abdominal infection yes Observational, meta-analysis NR + Low PCT post-surgical ensure safe discharge, PCT is similar to CRP [58, 59]
Postoperative infections yes RCTs, Observational <0.5–2.0 ++ Low PCT suggests absence of perioperative infection and enables early discharge  
Other Arthritis yes Observational <0.5 + PCT identifies infection in patients with rheumatoid arthritis [94]
Erysipelas yes Observational <0.1 + PCT differentiates erysipelas from DVT [81]
Meningitis no RCT, meta-analysis (N = 2058) <0.5 +++ PCT reduces AB treatment during viral outbreak; serum PCT with CSF lactate reliably identifies bacterial meningitis [72, 74]
  1. Abbreviations: AB antibiotic, AECOPD acute exacerbation of chronic obstructive pulmonary disease, CSF cerebral spinal fluid, CRP C-reactive protein, ED emergency department; ICU intensive care unit; NR not reported, PCT procalcitonin, RCT randomized controlled trial. The level of evidence in favor or against PCT for each infection was rated by two of the coauthors (PS, RSA) independently and disagreements were resolved by consensus. +: moderate evidence in favor of PCT; ++: good evidence in favor of PCT; +++: strong evidence in favor of PCT; –: no evidence in favor of PCT