ProCon debate Is procalcitonin useful for guiding antibiotic decision making in critically ill patients 英文参考文献.docVIP

Available online /content/12/3/211 Review Pro/Con debate: Is procalcitonin useful for guiding antibiotic decision making in critically ill patients? Yahya Shehabi1 and Ian Seppelt2 1Acute Care Clinical Program, Intensive Care and Research, Prince of Wales Hospital, University of New South Wales, Barker Street, Randwick, NSW 2031, Australia 2Department of Intensive Care Medicine, Nepean Hospital, University of Sydney, Derby Street, Penrith, NSW 2751, Australia Corresponding author: Yahya Shehabi, y.shehabi@.au Published: 2 May 2008 Critical Care 2008, 12:211 (doi:10.1186/cc6860) This article is online at /content/12/3/211 ? 2008 BioMed Central Ltd Abstract More specifically, a useful sepsis biomarker should do the following [4]: (a) add value to the clinical evaluation, (b) shorten the time to definitive diagnosis, and (c) differentiate infectious and bacterial from noninfectious or nonbacterial causes. The utility of a biomarker is enhanced if it reflects (i) the severity of infection and the septic process and (ii) the effectiveness of therapy, including antibiotics, earlier and more accurately than clinical convention. You are concerned about the escalating use of antibiotics in your intensive care unit (ICU). This has put a strain on the ICU budget and is possibly resulting in the emergence of resistant bacteria. You review the situation with your team and one suggestion is to consider using biomarkers such as procalcitonin to better guide appropriate antibiotic decision making. Pro: Time for goal-directed procalcitonin- guided antibiotic therapy in the intensive care unit Procalcitonin (PCT) normally has a plasma level of less than 0.1μg/L (ng/mL) in healthy subjects. Levels rise substantially in response to triggers released during bacterial and systemic infections, in particular endotoxin and inflammatory cytokines. The elimination half-life of PCT is between 22 a