Procalcitonin in the Assessment of Ventilator Associated Pneumonia: A Systematic Review
Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infection, associated with considerable mortality and morbidity in critically ill patients; however, its diagnosis and management remain challenging since clinical assessment is of
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Procalcitonin in the Assessment of Ventilator Associated Pneumonia: A Systematic Review Francesco Alessandri, Francesco Pugliese, Silvia Angeletti, Massimo Ciccozzi, Alessandro Russo, Claudio M. Mastroianni, Gabriella d’Ettorre, Mario Venditti, and Giancarlo Ceccarelli Abstract
Background Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infection, associated with considerable mortality and morbidity in critically ill patients; however, its diagnosis and management remain challenging since clinical assessment is often poorly reliable. The aim of this systematic review was to evaluate the role of PCT in the diagnosis and management of critical ill patients affected by VAP. F. Alessandri and F. Pugliese Department of Anaesthesia and Critical Care Medicine, University of Rome “Sapienza”, Rome, Italy Azienda Policlinico Umberto I, Rome, Italy S. Angeletti Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy M. Ciccozzi Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy A. Russo Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy C. M. Mastroianni, G. d’Ettorre, M. Venditti, and G. Ceccarelli (*) Azienda Policlinico Umberto I, Rome, Italy Department of Public Health and Infectious Diseases, University of Rome “Sapienza”, Rome, Italy e-mail: [email protected]
Methods We performed a systematic review of the evidence published over the last 10 years and currently available in medical literature search databases (Pubmed, Embase, Web of Knowledge, Cochrane Libraries) and searching clinical trial registries. We regarded as predefined outcomes the role of PCT in diagnosis, therapeutic monitoring, antibiotic discontinuation and prognosis. The Open Science Framework Registration number was doi. org/10.17605/OSF.IO/ZGFKQ Results 761 articles were retrieved and a total of 18 studies (n of patients ¼ 1774) were selected and analyzed according to inclusion criteria. In this 2020 update, the systematic review showed that currently, conflicting and inconclusive data are available about the role of PCT in the diagnosis of VAP and in the prediction (i) of the efficacy of antibiotic therapy, and (ii) of the clinical outcome. These studies, instead, seem to agree on the utility of PCT in the management of antibiotic therapy discontinuation. Conclusions Currently there is insufficient evidence to support the role of PCT in the routine assessment of patients with VAP. The value of the results published appears to be limited by the deep methodological differences that characterize the various studies available at the present being.
F. Alessandri et al.
Keywords
Procalcitonin · PCT · Ventilator associated pneumonia · VAP · Pneumonia · Systematic review · ICU · Intensive care unit · Critical care · Driven discontinuation · Antibiotic therapy · Antibiotic stewardship
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Introduction
Ventilator associated pneumonia (VAP) is one of the most common hospital-acquired infection occurring i
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