Procalcitonin to guide duration of antibiotic therapy in intensive care patients: some research questions

Abstract

The article by Hochreiter and colleagues on the use of procalcitonin to guide duration of antibiotic therapy in intensive care patients is timely and significant, but it raises a number of unresolved issues [1]. First, it was entirely appropriate that the physician in charge of the surgical intensive care ward had the option to proceed with or to adjust the antibiotic treatment if there were clinical reasons to do so. Whether such adjustments were made either in the control group or in the procalcitonin-guided antibiotic therapy group, however, is not clear. Second, Table 1 in their article indicates a longer number of days in intensive care for those patients in the control group than for those undergoing procalcitonin-guided antibiotic therapy [1]. Since 36% of the patients in each group did not survive, however, the length of stay in intensive care for both groups may be confounded by death. Finally, again in Table 1 [1], were there differences in outcome for those patients diagnosed with pneumonia and those diagnosed with peritonitis in either the control group or the procalcitonin-guided antibiotic therapy group? Despite more than 10 years of research into the usefulness of procalcitonin therapy, Hausfater is right to point out that 'its exact place in the diagnostic process remains to be defined' [2]. Both the articles of McLean and of Christ-Crain and Muller have proposed further study of alternative novel biomarkers [3,4]. Early diagnosis of sepsis linked to timely but limited use of antibiotics remains paramount, whichever biomarkers make it possible to save more patients' lives in intensive care.