Spectrum: Local Antimicrobial Stewardship, for Billings Clinic

Unstable or ICU Patients

Start antibiotics regardless of PCT level if a bacterial infection is suspected

When to Order

Initial patient evaluation to help differentiate sepsis from other noninfectious causes of SIRS and to assist in de-escalation later in hospitalization.

PCT is a reasonable marker to help guide de-escalation of antibiotic therapy .

How to Interpret PCT Levels

<0.25μg/L or drop by >90%

  • Antibiotic de-escalation or cessation strongly encouraged

  • Consider continuing antibiotic therapy if patient clinically unstable, regardless of PCT level

0.25-0.49μg/L or drop by >80%

  • Antibiotic de-escalation or cessation encouraged

  • Consider continuing antibiotic therapy if patient clinically unstable, regardless of PCT level

0.50-1.00μg/L

  • Antibiotic de-escalation or cessation discouraged

  • Consider continuing antibiotic therapy if patient clinically unstable, regardless of PCT level

&gt;1.00μg/L

  • Antibiotic de-escalation or cessation strongly discouraged

  • Consider continuing antibiotic therapy if patient clinically unstable, regardless of PCT level

How to Follow Up

Periodic monitoring of PCT levels may be considered in critically ill patients to assist with cessation or de-escalation of antibiotic therapy for suspected bacterial infections.

It is reasonable to check PCT every 48-72 hours to consider early cessation of antibiotics.

Exclusion:

  • Pregnancy

  • Immunocompromised

  • Localized infections or infections that require longer durations of treatment (ie endocarditis, osteomyelitis, Staphylococcus aureus bacteremia, etc)

If PCT levels do no respond to antibiotics within 48 hours and/or patient is clinically deteriorating, it is reasonable to change antibiotic therapy and/or consider source control and a noninfectious workup.