Clinicians can rely on Elecsys BRAHMS PCT to provide diagnostic clarity to help them avoid unnecessary antiobiotics1,2 when assessing risks and making decisions about: 4
As many as 71% of patients with acute respiratory tract infections are treated with antibiotics, despite a mainly viral cause for these infections.5
As a sensitive and specific biomarker of the inflammatory response to bacterial infection, Elecsys BRAHMS PCT aids clinicians in determining a patient’s risk of progression to sepsis and septic shock.
When a bacterial infection occurs, toll-like receptors flag the presence of microbial toxins. Inflammatory cytokines, such as Interleukin 1 beta (IL-1ß), Tumor Necrosis Factor alpha (TNF-α) and Interleukin 6 (IL6), are simultaneously secreted from the cell. Signaling pathways then stimulate PCT transcription, typically over three to six hours.8, 9
If the pathogen is not contained, infection spreads and the body up-regulates pro-inflammatory mediators, causing a dramatic increase in serum PCT for another 12 to 24 hours.10
It can take nearly 24 hours of appropriate antibiotic therapy to see reduction in plasma PCT levels as the bacterial infection is controlled, which will be reflected in a decrease in PCT production and circulating concentrationsby up to 50% per day. However, if initial antibiotic therapy or source control is not adequate, bacteria will continue to stimulate PCT production and blood concentrations will remain high.11
During viral infections, PCT production is lessened by Interferon gamma (IFN-γ) that is released during the host response to the virus.11 Thus, PCT concentration will not rise in viral infections as it does in the presence of a bacterial infection.
The utility of PCT as a tool for assessing the risk of bacterial infection stems from its unique kinetics, triggered from the inflammatory response to a bacterial infection.
1 Broyles, M.R. Impact of Procalcitonin-Guided Antibiotic Management on Antibiotic Exposure and Outcomes: Real-world Evidence, Open Forum Infectious Diseases, Volume 4, Issue 4, 1 October 2017, ofx213, https://doi.org/10.1093/ofid/ofx213 (accessed September 21, 2018).
2 Schuetz, P., M. Christ-Crain, R. Thomann, C. Falconnier, M. Wolbers et al. (September 2009). Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA 302(10):1059-1066 (doi:10.1001/jama.2009.1297).
3 Balk, A. et al. (January 2017). Procalcitonin Testing on Health-care Utilization and Costs in Critically Ill Patients in the United States. Chest 15(1):23-33. Available at: https:doi.org/10.1016/j.chest.2016.06.046 (accessed November 8, 2017).
4 Elecsys® BRAHMS PCT Package Insert, 2018.
5 Macfarlane, J., S.A. Lewis, R. Macfarlane and W. Holmes. (1997). Contemporary use of antibiotics in 1089 adults presenting with acute lower respiratory tract illness in general practice in the U.K. Respir Med 91(7):427–434.
6 Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs. https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.html (accessed May 11, 2018).
7 Thermo Scientific. A valuable tool for sepsis risk assessment and critical care management. Thermo Scientific Diagnostics website. http://diagnostics.thermofisher.com/content/dam/diagnostics/en/healthcare-providers/Documents/CDD/brahms-pct/PCT-Moses%20Brochure%20BRO6006B_E_US%2002-16T.pdf. Published February 2016 (accessed November 9, 2016).
8 Müller B., J.C. White, E.S. Nylén, R.H. Snider, K.L. Becker, and J.F. Habener. (2001). Ubiquitous expression of the calcitonin-I gene in multiple tissues in response to sepsis. J Clin Endocrinol Metab 86(1):396–404.
9 Becker, K.L., E.S. Nylén, J.C. White, B. Müller, and R.H. Snider Jr. (2004). Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab 89(4):1512–1525.
10 Meisner, M. Procalcitonin (PCT): A new, innovative infection parameter: biochemical and clinical aspects. Stuttgart, Germany: Thieme Medical Publishers, 2000.
11 Samraj, R.S., B. Zingarelli, and H.R. Wong. (2013). Role of biomarkers in sepsis care. Shock 40(5): 358–365.
12 Kumar, A. et al. (June 2006). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34(6):1589–1596.