International journal of antimicrobial agents
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The serum procalcitonin (PCT) concentration reflects both the systemic response to bacterial infection and its severity. However, its accuracy in distinguishing intensive care unit (ICU) patients with and without infection remains low owing to a lack of specificity and the time lapse between infection onset and the PCT rise. Hence, PCT cannot be used as a marker to start or withhold antibiotic therapy for ICU patients. ⋯ PCT-guided algorithms to guide antibiotic discontinuation were able to shorten antibiotic duration without impacting patient outcomes in several multicentre randomised studies. Notably, antibiotics can be stopped very early when PCT is low and remains low as this indicates that bacterial infection is unlikely. When PCT falls to <0.5 ng/mL or >80% from its peak value, antibiotics for non-localised infections can safely be stopped.
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Int. J. Antimicrob. Agents · Dec 2015
Can we transfer pharmacokinetics/pharmacodynamics of antimicrobials into clinical practice?
In critically ill patients there is extensive evidence of subtherapeutic antibiotic exposure from standard doses across different antibiotic classes. This can be a direct consequence of pharmacokinetic alterations emanating from the complex pathophysiological processes associated with severe infection. ⋯ In clinical practice, it is necessary to reduce the number of blood samples collected from the patient to a minimum because of the cost (personnel, devises and analysis). TDM to calculate PK/PD indices is easily feasible only when a single blood sample is adequate to perform the analysis.