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Article On Infectious Diseases

   

Added on  2020-02-19

12 Pages3302 Words48 Views
Running Head: INFECTIOUS DISEASESInfectious DiseasesName of the StudentName of the University Author Note

1INFECTIOUS DISEASESIntroductionThe reflective journal report is based on the article, “Procalcitonin-guided diagnosis andantibiotic stewardship revisited” (1). The article is the narrative review on the potential of theinfection biomarker procalcitonin in infections other than the respiratory tract infections andsepsis. The aim of the article is to determine the clinical utility for procalcitonin or PCT in otherinfections such as Urinary tract infections, meningitis, and other superficial infections. The useof antibiotic treatment can be challenging for physicians due to ambiguity in using theconventional diagnostic markers such as C reactive protein and blood cultures in-patientsuspected to have infection. The limitation pertains to the sensitivity and specificity (2).Antibiotic treatment for prolonged period has adverse consequences. In fifty per cent of thecases, the antimicrobial use has been found inappropriate and is unneeded in inpatient setting (3).It may lead to the antibiotic resistance and collateral damage such as“Clostridiumdiffiicile-associated diarrhea”. Recently, there is an increasing focus on the Procalcitonin, as an infectionmarker. Under normal circumstances it is produced by the thyroid C cells. However, in the caseof bacterial infections, PCT is produced by many body tissues and it parallels to the severity ofthe inflammatory insult. Further, it is the prognostic indicator that the higher serum level of PCTis associated with the risk of mortality (2, 4).There is a growing body of literature on the use of PCT for the rationale use of theantibiotics. Thus, strong scientific evidence is needed to diagnose the bacteria infection usingthis marker, so that the antibiotic treatment can be reduced in duration when compared to otherstandard care. Thus, it is important to determine the efficacy of the PCT guided therapy. Thebenefits may include quick diagnosis, reduced hospital stay of patients even in severe sepsis and

2INFECTIOUS DISEASESmortality (1, 3). If the clinical evidence is strong, the clinicians will be benefited. They canquickly diagnose the bacterial infections and treat on time, to prevent the clinical outcomes. Theaim of the reflective journal is to summarise the selected journal article and critically evaluatethe content of the research paper. Lastly, the overall summary is discussed based on the criticallyappraisal. Summary of articleIn the article by (1), the author has intended to update the clinicians on the newindications for PCT after the review published in 2011 indicating the use of prolactin indiagnosis and treatment of the lower respiratory tract infections and sepsis. This author of thearticle has performed a narrative review of the studies published in the period 2012-2013. Thereview includes various observational and interventional research and study designs. Most of thestudy designs selected were randomised control trials (RCT), RCT with real life (registry), meta-analysis of the RCTs, observational RCT of secondary analysis, only observational metaanalysisstudy, and only observational study. These chosen studies have investigated the use of the PCTin different types of infections and at different sites. The rationale for this narrative review is theinappropriate use of the antibiotics. With the emerging bacterial infections and antimicrobialresistance, there is an urgent call for intense efforts to deal with the self-limiting nonbacterial andresolving diseases (5). There is a need of the “one size fits all” approach. This narrative reviewby (1) may add to the growing body of literature, highlighting a useful strategy for antibioticstreatment reduction. In the given article, pulmonary site, the infections covered are AECOPD, Asthma,bronchitis, community acquired immunity, and pulmonary fibrosis and upper respiratory

3INFECTIOUS DISEASESinfections. The infections related to heart studied are congestive heart failure, and endocarditis.The infections related to abdominal region covered are pancreatitis, appendicitis abdominalinfections with peritonitis, and urinary tract infections. The blood related infections that areconsidered for determining the efficacy of PCT are Blood stream infection, Neutropenia andSevere sepsis/ shock. Some studies are included in the narrative review and deal with otherinfections such as arthritis, erysipelas, meningitis, and postoperative infections. Lastly, the articledraws conclusion based on the results from different studies (1). Critical evaluation of the articleThe strength of the narrative paper is the flexibility of narratives (7). The author hasfocused on the broad picture of the Procalcitonin-guided diagnosis. The article has presented acomprehensive background on the chosen research area and the related gaps in this domain (1).The article contains wide range of relevant information on the Procalcitonin-guided diagnosisand its potential as infection biomarker. The strength of the study is the comprehensive details onthe limitations of PCT (6). The interpretation of role of PCT is made carefully. The drawback ofPCT related to suboptimal sensitivity and specificity was necessary to get idea of its clinicalimplication (1, 2). The literature review could have been presented in the article (1) precisely, instead ofdirectly starting with the review (8). The article grabs the reader’s attention as it had clearquestion and focused on range of infections. The review has specified the type of the studiesconsidered that makes easy for the readers to comprehend the methodology. It is the advantageof the study (9). However, the narrative review is limited due to lack of presentation of thesearch strategy, inclusion and exclusion criteria. Thus, it remains ambiguous if the researcher had

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