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Procalcitonin-guided diagnosis and antibiotic stewardship revisited

   

Added on  2020-04-07

13 Pages3688 Words460 Views
Running Head: INFECTIOUS DISEASESInfectious DiseasesName of the StudentName of the University Author Note

1INFECTIOUS DISEASESIntroductionThe reflective journal report reviews the article, “Procalcitonin-guided diagnosis andantibiotic stewardship revisited” (1). It is the narrative review on the utility of the infectionbiomarker procalcitonin. The article is focused on the potential of the biomarker in infectionsexcluding the sepsis and respiratory related infections. The aim of the chosen article was todetermine the importance of the procalcitonin or PCT clinically. The article tend to highlightthe clinical utility of this biomarker in infections such as meningitis, Urinary tract infections,and others. There lies an ambiguity in using the convectional diagnostic markers. It makeschallenging for the physician to use the antibiotic treatment for patients with high C reactiveprotein and whose blood cultures indicate of infections. These conventional diagnosticmarkers have several limitations and the main ones poor sensitivity and specificity (2). Whenthe antibiotic treatment is used for prolonged period, it has adverse consequences. Theantimicrobial use was found unneeded in 50% of the cases (3) and was inappropriate ininpatient setting. The consequences may include antibiotic resistance. Collateral damage suchas C. difficle associated Diarrhea may be other outcomes. There is greater focus on PCTrecently due to its increasing attention as infectious marker. It is produced by the thyroid Ccells under normal circumstances. In case of bacterial infections, many body tissues producesPCT. This condition may be similar to the severity associated with the inflammatory insult. Inaddition, PCT is the prognostic indicator. A risk of mortality is indicated with the higherserum level of PCT (2,4).There is increasing literature evidence on the importance of PCT and its applicationfor using antibiotics rationally. There is a need of strong scientific evidence to use this markerfor diagnosing the bacterial infection. It will help in reducing the antibiotic treatment forprolonged period. In comparison to other treatment or standard of care the duration of the

2INFECTIOUS DISEASESantibiotic treatment can be reduced. Hence, the efficacy of the PCT guided therapy isimportant to be determined. The benefits of PCT may include faster diagnosis, and decreasein mortality by reducing the hospital stay of patient even in severe sepsis (1,3). The clinicianswill be benefitted by having a strong clinical evidence. Treatment can be enhanced by fasterdiagnosis of the bacterial infections. Patient can be treated on time to ensure positive healthoutcomes. The reflective journal aims to critically evaluate the selected journal article andbriefly summarise the content of the research paper. Based on the critical appraisal, theoverall summary is discussed.Summary of articleIn the selected research article, the new indications for PCT has been highlighted bythe author to update the clinicians on the potential biomarker. The author presented the articleas an outcome of the review published in 2011 that highlighted the PCT use in diagnosis andtreatment of sepsis and lower respiratory tract infections. Thus, the author of the chosenarticle conducted a narrative review of the PCT studies published between 2012-2013. In thisreview, the author considered various observational and interventional research and studydesigns. The study designs selected mostly includes RCT (randomised control trials), meta-analysis of the RCTs, RCT with real life (registry), observational RCT of secondary analysis,only observational studies and observational metaanalysis studies. These studies werepreferred by the author as they are highly focused on the use of the PCT for differentinfection types at various sites. The focus of author for this narrative review was the irrationaluse of the antibiotics. With plethora of bacterial infections emerging and increase in theantimicrobial resistance, there is a call for intense efforts to fight the “self-limitingnonbacterial and resolving diseases” (5). As per the scenario, “one size fits all” approach is

3INFECTIOUS DISEASESneeded in present condition. Therefore, this narrative review (1) may add to the existingliterature and help with strategy for reduction of the antibiotics treatment.The article covers the pulmonary related infections such as Asthma, pulmonaryfibrosis, community acquired immunity, AECOPD, bronchitis, and upper respiratoryinfections. The heart related infections studied by the author includes congestive heart failure,and endocarditis. The narrative review presented the abdominal region infections such aspancreatitis, appendicitis and associated peritonitis. It also covered the urinary tractinfections. The narrative review also considered the blood related infections for identifyingthe efficacy of PCT. It includes Neutropenia, Blood stream infection, and Severe sepsis/shock. The narrative review also includes other infections such as erysipelas, meningitis,arthritis, and postoperative infections. Based on the analysis of the results from differentstudies, the article draws conclusion pertaining to significance of PCT (1).Critical evaluation of the articleThe flexibility of the narratives is the strength of the article selected (6). The broadpicture of the PCT guided diagnosis was highlighted. The article by (1), comprehensivelydiscussed the background of the research area chosen for the review and the considered theresearch gaps in this domain. The information on PCT was relevant and a bulk of relatedinformation pertaining to PCT as potential infection marker was given. The author of thenarrative review presented the limitations of PCT. It constitutes the strength of the paper (6).The author made a careful interpretations of the role of PCT. To get the idea on the clinicalimplications, it was necessary to know the drawback of PCT related to suboptimal sensitivityand specificity (1, 2). The literature review on the topic was missing in the review. Precisely the author (1)could have presented the previous literature. Instead, the article directly started with the

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