PCT guides the hierarchical management of adult lower respiratory tract infectious diseases, a list of expert consensus recommendations!

Plasma marker procalcitonin (PCT) helps distinguish bacterial and non-bacterial infections, and including it in the overall evaluation index of infectious diseases can provide patients with diagnosis and treatment decisions; at the same time, it can safely reduce the prescription rate of antibacterial drugs and shorten The course of anti-infective treatment reduces the rate of bacterial resistance.

"Expert Consensus on the Application of Procalcitonin in the Classification Management of Adult Lower Respiratory Tract Infectious Diseases (LRTI)" is a multidisciplinary team composed of experts from the national emergency medicine, respiratory disease, infectious disease, microbiology and other related fields Discuss and formulate together.

➤Special emphasis: PCT is an auxiliary diagnostic index.
Clinical decision-making cannot be made based on this isolated index alone.
It must be combined with LRTI patients' medical history, clinical manifestations, physical examination findings and other auxiliary examination results for comprehensive evaluation.

Overview of main recommendations [Recommendation 1] According to the different types and severity of LRTI infections, different PCT thresholds should be used for infection classification management.

The antimicrobial management of patients with mild to moderate LRTI is guided by a PCT threshold of 0.
25 µg/L, and patients with severe LRTI are guided by a threshold of PCT 0.
5 µg/L, as shown in Table 1 and Table 2.

Table 1 PCT guides the use of antibacterial drugs in non-severe LRTI patients Table 2 PCT guides the use of antibacterial drugs in severe LRTI patients [Recommendation 2] The diagnostic threshold for excluding typical bacterial LRTIs is PCT 0.
25 μg/L, and this threshold can be used at the same time And the reference index for the termination of antimicrobial treatment.

[Recommendation 3] The use of a PCT<0.
25 μg/L threshold in combination with clinical symptoms can help support the diagnosis of LRTI caused by a simple virus.

[Recommendation 4] The PCT threshold of 0.
25 μg/L can provide guidance for patients with acute tracheobronchitis in the use of antimicrobials, while reducing the prescription of antimicrobials.

[Recommendation 5] The PCT threshold can provide antimicrobial guidance for patients with pneumonia of different severity.

The 0.
25 μg/L threshold was used for patients with mild to moderate pneumonia, and the 0.
5 μg/L threshold was used for patients with severe pneumonia.

When the PCT decline rate is >80%, it is encouraged to stop antibacterial drugs.

 a Take the application of antibacterial drugs in patients with pneumonia as an example.
Figure 1 Procalcitonin guides LRTI diagnosis and treatment path [Recommendation 6] PCT helps to identify AECB/AECOPD bacteria and viruses or non-infectious causes; PCT<0.
25 µg/L is not recommended Initiate antimicrobial treatment.

[Recommendation 7] Antibacterial drugs are not recommended for patients with bronchiectasis and bacterial infection with PCT<0.
25 μg/L.

[Recommendation 8] PCT testing has not yet achieved internationally recognized standardization, and each manufacturer PCT needs to establish its own threshold; to ensure safe and effective clinical decision-making, the PCT threshold used in clinical practice should be based on a large number of clinical studies and evidence.

The above content is extracted from: Expert consensus group on the application of procalcitonin in the graded management of adult lower respiratory tract infectious diseases.
Expert consensus on the application of procalcitonin in the graded management of adult lower respiratory tract infectious diseases.
Chinese Journal of Emergency Medicine, 2021, 30(4): 393-401.