Clin Chem Lab Med 2023; 61(5): 822–828

Opinion Paper

Philipp Schuetz*

How to best use procalcitonin to diagnose

infections and manage antibiotic treatment
https://doi.org/10.1515/cclm-2022-1072 stakeholders. Medical Journals such as Clinical Chemistry
Received October 25, 2022; accepted October 26, 2022; and Laboratory Medicine (CCLM) have played a critical
published online November 2, 2022
role in reviewing and dissemination the high-quality
evidence about assays for PCT measurement, observa-
Abstract
tional research regarding association with outcomes
Objectives: Procalcitonin (PCT) is a host-response among different populations, and interventional research
biomarker that has shown clinical value for assessing proofing its effectiveness for patient care.
the likelihood of bacterial infections and guiding anti- Keywords: antibiotic stewardship; bacterial infection;
biotic treatment. Identifying situations where PCT can biomarker; procalcitonin; respiratory tract infections; sepsis.
improve clinical care is therefore highly important.
Methods: The aim of this narrative review is to discuss
strategies for the usage and integration of PCT into clinical Introduction
routine, based on the most recent clinical evidence.
Results: Although PCT should not be viewed as a traditional Acute respiratory tract illnesses and suspected sepsis
diagnostic marker, it can help differentiate bacterial from non- often prompt initiation of empiric antibiotic treatment.
bacterial infections and inflammation states – particularly in In many cases, however, a bacterial pathogen cannot
respiratory illness. Several trials have found that PCT-guided be detected, as viruses account for a large proportion of
antibiotic stewardship reduces antibiotic exposure and asso- respiratory illnesses [1, 2]. The same is true in patients
ciated side-effects among patients with respiratory infection presenting with systemic inflammatory response syn-
and sepsis. Studies have demonstrated that patient-specific drome (SIRS) and possible sepsis – where other inflam-
decisions regarding antibiotic usage is highly complex. Fac- matory or viral illnesses may be the cause of a significant
tors to consider include: the clinical situation (with a focus on proportion of cases. Despite technological advances and
the pretest probability for bacterial infection), the acuity and the wide availability of rapid molecular diagnostics [3],
severity of presentation, as well as PCT test results. Low PCT antibiotics are often over-prescribed due to concerns
levels help rule out bacterial infection in patients with both
about bacterial coinfections and the risk of withholding
low pretest probability for bacterial infection and low-risk
therapy. Once started, physicians often prescribe pro-
general condition. In high-risk individuals and/or high pretest
longed courses of antibiotics due to lack of proof that
probability for infection, empiric antibiotic treatment is
the infection has been resolved. Unnecessarily long
mandatory. Subsequent monitoring of PCT helps track the
treatment also often results from the application of anti-
resolution of infection and guide decisions regarding early
biotic regimens advocated by standard practice guidelines.
termination of antibiotic treatment.
Individualizing antibiotic treatment may potentially
Conclusions: PCT possesses high potential to improve
improve antibiotic stewardship efforts to encourage judi-
decision-making regarding antibiotic treatment – when
cious and correct usage of these agents. This would further
combined with careful patient assessment, evidence-
mitigate the emergence of multi-drug resistant pathogens –
based clinical algorithms, and continuous notification
a situation directly linked to antibiotic overuse and one of
and regular feedback from all antibiotic stewardship
the most urgent health threats worldwide [4].
Regarding clinical care of patients with acute respira-
tory illnesses and sepsis, the integration of host response
*Corresponding author: Philipp Schuetz, MD, MPH, Department of
Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland; and
markers which correlate with the likelihood of bacterial
University of Basel, Basel, Switzerland, Phone: +41 (0) 79 365 10 06, infection has strong potential to improve individual anti-
Fax: +41 (0) 62 838 9524, E-mail: Philipp.Schuetz@unibas.ch biotic therapy decision-making [5]. Among such host-
 Schuetz: Procalcitonin to diagnose infections and manage antibiotic treatment 823

response markers, Procalcitonin (PCT) has generated much in 3,336 procalcitonin-guided patients vs. 336 [10%] in
interest due to its higher specificity towards bacterial 3,372 controls [p=0.037]). Similar effects were also seen
infection compared to C-reactive protein (CRP) or white for other respiratory infections and clinical settings.
blood cell count (WBC) [6, 7]. PCT also has a superior Another meta-analysis of 11 trials and 4,482 patients
prognostic [8] and kinetic profile to track infections – mak- investigated the effects of applying PCT in patients
ing it useful to assess response to treatment [7, 9–12]. with sepsis [14]. Those randomized to the PCT protocol
The goal of this narrative review is to discuss different experienced an earlier discontinuation of antibiotics
studies and clinical trials that have investigated clinical ef- and significant reductions in mean treatment duration
fects of using PCT for the purpose of antibiotic stewardship, from 10.4 to 9.3 days. Here again, mortality in PCT-guided
and to provide practical advice on how to best integrate PCT patients was significantly lower compared to the control
into clinical care. Thereby, several milestone studies about group (21.1 vs. 23.7%, p=0.03). In a further meta-analysis
PCT that were published in Clinical Chemistry and Laboratory of individuals with positive blood cultures, PCT reduced
Medicine (CCLM) over the last years are particularly high- both antibiotic exposure (by 2.86 days) and mortality
lighted and critically discussed. (16.6 vs. 20.0%) [17]. A subgroup analysis demonstrated
the strongest effects for pneumonia caused by Strepto-
coccus pneumoniae (−4.52 days) and urogenital infections
caused by Escherichia coli (−4.21 days).
Clinical trials investigating
PCT-guided antibiotic stewardship
In addition to a large body of observational data [13],
How to implement PCT in clinical
several interventional trials have compared PCT protocols practice
with control groups regarding antibiotic use and clinical
outcomes [14, 15]. Most trials focused on patients with Based on these trials, important considerations for PCT
respiratory infection and/or sepsis. Although the pro- use in clinical practice must be made. The interpretation
tocols followed slightly different PCT guidelines, there of PCT results varies according to clinical setting, specific
were some similarities: PCT cut-off values in low risk patient situation, and type of illness.
patients were used to identify individuals for whom In low risk patients in primary care, a marker such
bacterial infection was unlikely and antibiotic treatment as PCT can rule out bacterial disease and reduce anti-
could be stopped, or withheld [16]. If the probability biotic initiation [18]. Two large primary care PCT trials
for bacterial infection was high, the protocol focused examined a total of 1,008 patients with lower and up-
on PCT kinetics and cessation of antibiotics when PCT per respiratory tract infections – whereby a low PCT
levels dropped to normal ranges, or by at least 80–90%. of ≤0.25 μg/L prohibited the use of antibiotics [18, 19].
PCT protocols had varying cut-offs for low or higher Antibiotic initiation was reduced from 63% in control
acuity/severity: for emergency department and medical group patients to 23% in PCT-guided patients; with a
ward patients, a PCT<0.25 μg/L recommended no use of significant reduction in antibiotic exposure from 4.6
antibiotics, while in intensive care patients a PCT<0.5 μg/L to 1.6 days and no difference in clinical outcomes.
advocated discontinuation of antibiotics. Currently, the most significant limitation to the use of
There are several meta-analyses which have investi- PCT in primary care is the lack of highly sensitive
gated the effectiveness and safety of utilizing PCT to guide point-of-care tests. Furthermore, other markers such as
antibiotic treatment. One individual patient data meta- CRP – where tests are more widely available and less
analysis of 26 trials focusing on respiratory infections expensive – have shown benefit in primary care patients
reported that PCT guidance was associated with a 2.4-day despite their lower specificity regarding bacterial
reduction in antibiotic exposure (5.7 vs. 8.1 days). This infections [20]. As corresponding large scale head-to-
was due to decreased rates of antibiotic initiation in low- head trials are lacking, further study is needed to
risk patient (i.e., bronchitis or COPD patients) and shorter compare PCT-guided care with other biomarkers such as
treatment courses in high risk patients (i.e., pneumonia CRP. Cost-effectiveness and country-specific reimburse-
patients) [7, 15]. Importantly, use of PCT resulted in ment of PCT must also be addressed.
reductions of antibiotic-related side-effects (16 vs. 22%), Several trials of mostly respiratory infection patients
and in significantly lowered mortality (286 [9%] deaths have investigated PCT in the emergency department
824 Schuetz: Procalcitonin to diagnose infections and manage antibiotic treatment

setting. A study of over 500 patients with bronchitis Practical considerations

found significant reduction in initiation of antibiotics
(26 vs. 66%) when PCT was used as guideline [15]. Simi- Decisions regarding antibiotic use in individual patients
larly for COPD exacerbation, an analysis of more than is complex and should be based on several consider-
1,200 patients found significant reduction in the appli- ations including: the pretest probability for bacterial
cation of antibiotics with PCT-guided care (43 vs. 72%). infection (based on clinical examination and microbio-
PCT may also help emergency department personnel to logical findings), the severity of presentation, and PCT
discriminate between chronic heart failure patients with test results. Figure 1 provides a practical guide for the
decompensation vs. respiratory infection [21, 22]. For rational use of PCT in both high and low risk settings; in
cases with pneumonia, baseline PCT levels obtained conjunction with clinical assessment including inter-
in the emergency department help assess kinetics over pretation of PCT, and recommendations for antibiotic use
time and guide duration of antibiotic therapy. as discussed at a consensus conference of international
Several trials on pneumonia patients admitted to experts [16, 31].
medical wards have found that serial PCT measurements In low-risk situations (e.g., patient in primary care
and the termination of antibiotics when PCT dropped or on the medical ward) and a minimal pretest probability
by ≥80% (or to <0.25 μg/L) resulted in shorter treatment for bacterial infections (e.g., individuals presenting
durations, lower risk of adverse drug events, and improved with bronchitis), low PCT levels <0.25 μg/L help rule out
survival rates [23]. One meta-analysis of more than 3,000 bacterial infection and empiric antibiotic therapy should
pneumonia patients reported reductions in antibiotic be avoided. PCT should be retested if the patient does
treatment from 10.4 day to 7.5 days, and improvements in not improve clinically. Antibiotics should be considered
treatment failure (22 vs. 26%) and mortality (12 vs. 14%) if PCT increases, or initial clinical assessment indicates
[15]. The positive impact of PCT-guided antibiotic man- high probability of bacterial infection. PCT testing can
agement on mortality may be explained by various factors; then be undertaken every 24–48 h, with discontinuation
including a reduction of direct toxic effects of antibiotics, of antibiotics if levels drop to ≤0.25 μg/L or decrease by
a lowering of risk for antibiotic related Clostridium difficile 80% or more from peak values.
infections, and changes in diagnostic and therapeutic Concerning high-risk patient with sepsis, initial anti-
monitoring and management based on prognostic infor- biotics should be used irrespective of PCT results – but low
mation. Less trial data is available regarding the use of PCT values may prompt additional diagnostic measures
PCT in surgical patients [24] – where it is important to to rule out other non-bacterial causes of illness. In these
understand that inflammatory stress-induced increases in situations, monitoring of PCT over time helps track reso-
PCT concentrations correlate with the extent of surgery lution of infection and decision-making regarding early
[10]. One study indicated that PCT was highest on the termination of antibiotic treatment.
second day postop and typically declined thereafter in Finally, while most studies are performed in Europe
patients with uncomplicated recoveries. Persistently and the US, it is important to adapt existing algorithms
elevated PCT levels have been conversely associated for differences in type of infections in regions with tropical
with the development of postsurgical infection [25, 26]. diseases [32].
The acquisition of more data is necessary before PCT is
broadly implemented to assist management of post-
surgical complications. Limitations of procalcitonin
The intensive care unit is another important setting
where clinical trial data has demonstrated the usefulness of Most PCT studies investigate individuals with respiratory
PCT for antibiotic decision-making. Here, PCT-guided care infections or sepsis, and data is limited for immunosup-
does not focus on the initiation of antibiotics, but rather on pressed patients [11]. In addition, various non-infectious
determining clinical response to treatment and possible conditions such as C-cell carcinoma or trauma can cause
discontinuation of therapy [27]. Several large multicenter systemic inflammation and increases in PCT [33]. Also,
trials have found PCT helpful in reducing antibiotic exposure PCT-guided stewardship should not be applied to patients
[28, 29]. Most trials stopped antibiotic treatment when PCT with chronic infections such as osteomyelitis or endo-
decreased by ≥80% from its peak value; or to a level carditis, as observational studies have not shown positive
of ≤0.5 μg/L. A recent meta-analysis of PCT-guided antibiotic results and interventional research is lacking [31]. For
treatment found reductions in both duration of treatment emerging infections such as COVID-19, the role of PCT as
and mortality [14, 30]. a stewardship tool requires further study [34]. PCT is
 Schuetz: Procalcitonin to diagnose infections and manage antibiotic treatment 825

Figure 1: Clinical algorithm for PCT use in different clinical settings. (A) Suggested PCT protocol in low and moderate severity patients [31].
(B) Suggested PCT protocol in critical care patients [31].

also relatively low in some atypical infections – including large number of new PCT immunoassays are currently
mycoplasma [35]. Some clinical conditions such as kid- being developed (including point-of-care tests [38]),
ney failure and dialysis may influence PCT kinetics [36], which will require careful analysis and clinical evaluation
although one large individual patient meta-analysis [39–45]. The expansion of PCT assays also necessitates
suggested that use of PCT in patients with impaired evaluation of result comparability among tests and stan-
kidney function works well and is associated with shorter dardized calibration to support safe usage of PCT in
antibiotic courses and lower mortality rates [37]. Finally, a clinical routine [46–48]. Finally, cost-effectiveness
826 Schuetz: Procalcitonin to diagnose infections and manage antibiotic treatment

analyses are needed to evaluate how widespread PCT 3. Mitsuma SF, Mansour MK, Dekker JP, Kim J, Rahman MZ, Tweed-
testing would affect health care budgets – in comparison Kent A, et al. Promising new assays and technologies for the
diagnosis and management of infectious diseases. Clin Infect Dis
with the resulting benefits for clinical outcomes and
2013;56:996–1002.
antibiotic resistance patterns [49, 50]. 4. Jee Y, Carlson J, Rafai E, Musonda K, Huong TTG, Daza P, et al.
Antimicrobial resistance: a threat to global health. Lancet Infect
Dis 2018;18:939–40.
Concluding remarks 5. Hey J, Thompson-Leduc P, Kirson NY, Zimmer L, Wilkins D, Rice B,
et al. Procalcitonin guidance in patients with lower respiratory
tract infections: a systematic review and meta-analysis.
The medical community is highly interested in reducing Clin Chem Lab Med 2018;56:1200–9.
unnecessary antibiotic exposure in patients with acute res- 6. Bartoletti M, Antonelli M, Bruno Blasi FA, Casagranda I,
piratory illness and low risk for bacterial infection, as well as Chieregato A, Fumagalli R, et al. Procalcitonin-guided antibiotic
shortening therapy in cases of known bacterial infections. therapy: an expert consensus. Clin Chem Lab Med 2018;56:
1223–9.
Essentially, the aim is to shift from fixed antibiotic doses to
7. Zhydkov A, Christ-Crain M, Thomann R, Hoess C, Henzen C,
individualized treatment. As a marker of host defense Werner Z, et al. Utility of procalcitonin, C-reactive protein and
response, PCT has shown promising results for respiratory white blood cells alone and in combination for the prediction of
infections and sepsis. PCT should not be used as a sub- clinical outcomes in community-acquired pneumonia. Clin Chem
stitute for good clinical practice, but rather be part of the Lab Med 2015;53:559–66.
8. Sager R, Wirz Y, Amin D, Amin A, Hausfater P, Huber A, et al. Are
overall assessment of a patient. Decisions pertaining to
admission procalcitonin levels universal mortality predictors
initiation and cessation of antibiotic treatment remains
across different medical emergency patient populations? Results
strongly dependent on evaluating all available clinical from the multi-national, prospective, observational TRIAGE
and diagnostic parameters, including a thorough assess- study. Clin Chem Lab Med 2017;55:1873–80.
ment of the patient and severity of illness. Furthermore, 9. Schuetz P, Birkhahn R, Sherwin R, Jones AE, Singer A, Kline JA,
PCT usage should not delay or impede initiation of et al. Serial procalcitonin predicts mortality in severe sepsis
patients: results from the multicenter procalcitonin MOnitoring
empirical treatment in high-risk situations. Host response
SEpsis (MOSES) study. Crit Care Med 2017;45:781–9.
markers such as PCT, however, remain the best line of 10. Sager R, Kutz A, Mueller B, Schuetz P. Procalcitonin-guided
defense against diagnostic uncertainty and antibiotic diagnosis and antibiotic stewardship revisited. BMC Med 2017;
overuse. Further research is needed to explore the optimal 15:15.
application of biomarkers in combination with pathogen- 11. Lippi G, Cervellin G. Procalcitonin for diagnosing and monitoring
bacterial infections: for or against? Clin Chem Lab Med 2018;56:
directed tests. Importantly, medical Journals such as
1193–5.
Clinical Chemistry and Laboratory Medicine (CCLM) have
12. Schuetz P, Hausfater P, Amin D, Amin A, Haubitz S, Faessler L,
played a critical role in reviewing and dissemination the et al. Biomarkers from distinct biological pathways improve early
high-quality evidence about assays for PCT measurement, risk stratification in medical emergency patients: the
observational research regarding association with out- multinational, prospective, observational TRIAGE study. Crit Care
comes among different populations, and interventional 2015;19:377.
13. Schuetz P, Aujesky D, Muller C, Muller B. Biomarker-guided
research proofing its effectiveness for patient care.
personalised emergency medicine for all – hope for another
hype? Swiss Med Wkly 2015;145:w14079.
Research funding: None declared. 14. Wirz Y, Meier MA, Bouadma L, Luyt CE, Wolff M, Chastre J, et al.
Author contributions: Single author contribution. Effect of procalcitonin-guided antibiotic treatment on clinical
Competing interests: Dr. Schuetz reports grants from outcomes in intensive care unit patients with infection and sepsis
patients: a patient-level meta-analysis of randomized trials.
bioMerieux, Thermofisher, and Roche Diagnostics (paid
Crit Care 2018;22:191.
to the Institution).
15. Schuetz P, Wirz Y, Sager R, Christ-Crain M, Stolz D, Tamm M, et al.
Informed consent: Not applicable. Effect of procalcitonin-guided antibiotic treatment on mortality in
Ethical approval: Not applicable. acute respiratory infections: a patient level meta-analysis. Lancet
Infect Dis 2018;18:95–107.
16. Schuetz P, Bolliger R, Merker M, Christ-Crain M, Stolz D, Tamm M,
References et al. Procalcitonin-guided antibiotic therapy algorithms for
different types of acute respiratory infections based on previous
1. Musher DM, Thorner AR. Community-acquired pneumonia. N Engl trials. Expert Rev Anti Infect Ther 2018;16:555–64.
J Med 2014;371:1619–28. 17. Meier MA, Branche A, Neeser OL, Wirz Y, Haubitz S, Bouadma L,
2. Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Procalcitonin-guided antibiotic treatment in patients with
et al. Community-acquired pneumonia requiring hospitalization positive blood cultures: a patient-level meta-analysis of
among U.S. adults. N Engl J Med 2015;373:415–27. randomized trials. Clin Infect Dis 2019;69:388–96.
 Schuetz: Procalcitonin to diagnose infections and manage antibiotic treatment 827

18. Odermatt J, Friedli N, Kutz A, Briel M, Bucher HC, Christ-Crain M, Pacific countries: adaptation based on an expert consensus
et al. Effects of procalcitonin testing on antibiotic use and clinical meeting. Clin Chem Lab Med 2020;58:1983–91.
outcomes in patients with upper respiratory tract infections. 33. Kratzsch J, Willenberg A, Frank-Raue K, Kempin U, Rocktaschel J,
An individual patient data meta-analysis. Clin Chem Lab Med Raue F. Procalcitonin measured by three different assays is an
2017;56:170–7. excellent tumor marker for the follow-up of patients with
19. Schuetz P, Wirz Y, Sager R, Christ-Crain M, Stolz D, Tamm M, et al. medullary thyroid carcinoma. Clin Chem Lab Med 2021;59:
Procalcitonin to initiate or discontinue antibiotics in acute 1861–8.
respiratory tract infections. Cochrane Database Syst Rev 2017;10: 34. Dolci A, Robbiano C, Aloisio E, Chibireva M, Serafini L, Falvella FS,
CD007498. et al. Searching for a role of procalcitonin determination in
20. Do NT, Ta NT, Tran NT, Than HM, Vu BT, Hoang LB, et al. Point-of- COVID-19: a study on a selected cohort of hospitalized patients.
care C-reactive protein testing to reduce inappropriate use of Clin Chem Lab Med 2020;59:433–40.
antibiotics for non-severe acute respiratory infections in 35. Neeser OL, Vukajlovic T, Felder L, Haubitz S, Hammerer-Lercher A,
Vietnamese primary health care: a randomised controlled trial. Ottiger C, et al. A high C-reactive protein/procalcitonin ratio
Lancet Global Health 2016;4:e633–41. predicts Mycoplasma pneumoniae infection. Clin Chem Lab Med
21. Schuetz P, Daniels LB, Kulkarni P, Anker SD, Mueller B. 2019;57:1638–46.
Procalcitonin: a new biomarker for the cardiologist. Int J Cardiol 36. Ceccarelli G, Alessandri F, Sargentini V, D’Alessandro MD,
2016;223:390–7. Spaziante M, Bachetoni A, et al. Impact of continuous renal
22. Schuetz P, Kutz A, Grolimund E, Haubitz S, Demann D, Vogeli A, replacement therapy (CRRT) and other extracorporeal support
et al. Excluding infection through procalcitonin testing improves techniques on procalcitonin guided antibiotic therapy in critically
outcomes of congestive heart failure patients presenting with ill patients with septic shock. Clin Chem Lab Med 2019;57:e86–7.
acute respiratory symptoms: results from the randomized 37. Heilmann E, Gregoriano C, Wirz Y, Luyt CE, Wolff M, Chastre J,
ProHOSP trial. Int J Cardiol 2014;175:464–72. et al. Association of kidney function with effectiveness of
23. Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, procalcitonin-guided antibiotic treatment: a patient-level meta-
Widmer I, et al. Effect of procalcitonin-based guidelines vs analysis from randomized controlled trials. Clin Chem Lab Med
standard guidelines on antibiotic use in lower respiratory tract 2020;59:441–53.
infections: the ProHOSP randomized controlled trial. JAMA 2009; 38. Kutz A, Hausfater P, Oppert M, Alan M, Grolimund E, Gast C, et al.
302:1059–66. Comparison between B.R.A.H.M.S PCT direct, a new sensitive
24. Aoki Y, Taniai N, Yoshioka M, Kawano Y, Shimizu T, Kanda T, et al. point-of-care testing device for rapid quantification of
Serum procalcitonin concentration within 2 days postoperatively procalcitonin in emergency department patients and established
accurately predicts outcome after liver resection. Clin Chem Lab reference methods – a prospective multinational trial. Clin Chem
Med 2018;56:1362–72. Lab Med 2016;54:577–84.
25. Hunziker S, Hugle T, Schuchardt K, Groeschl I, Schuetz P, 39. Schuetz P, Bretscher C, Bernasconi L, Mueller B. Overview of
Mueller B, et al. The value of serum procalcitonin level for procalcitonin assays and procalcitonin-guided protocols for the
differentiation of infectious from noninfectious causes of fever management of patients with infections and sepsis. Expert Rev
after orthopaedic surgery. J Bone Joint Surg 2010;92:138–48. Mol Diagn 2017;17:593–601.
26. Bouaicha S, Blatter S, Moor BK, Spanaus K, Dora C, Werner CM. 40. Lippi G, Salvagno GL, Gelati M, Pucci M, Lo Cascio C, Demonte D,
Early serum procalcitonin level after primary total hip et al. Two-center comparison of 10 fully-automated commercial
replacement. Mediat Inflamm 2013;2013:927636. procalcitonin (PCT) immunoassays. Clin Chem Lab Med 2019;58:
27. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, 77–84.
et al. Surviving sepsis campaign: international guidelines for 41. Dupuy AM, Ruffel L, Bargnoux AS, Badiou S, Cristol JP. Analytical
management of severe sepsis and septic shock, 2012. Intensive evaluation of the performances of a new procalcitonin
Care Med 2013;39:165–228. immunoassay. Clin Chem Lab Med 2022;60:77–80.
28. Landman GW, Kleefstra N. Procalcitonin in intensive care units: 42. Choi H, Tashpulatova Z, Moon SY, Choi J, Kim JY, Lee SM. Evaluation
the PRORATA trial. Lancet 2010;375:1606. author reply-7. of the Beckman Coulter access procalcitonin assay: analytical and
29. de Jong E, van Oers JA, Beishuizen A, Vos P, Vermeijden WJ, clinical performance. Clin Chem Lab Med 2022;60:e50–3.
Haas LE, et al. Efficacy and safety of procalcitonin guidance in 43. Jensch A, Mahla E, Toller W, Herrmann M, Mangge H.
reducing the duration of antibiotic treatment in critically ill Procalcitonin measurement by Diazyme immunturbidimetric and
patients: a randomised, controlled, open-label trial. Lancet Infect Elecsys BRAHMS PCT assay on a Roche COBAS modular analyzer.
Dis 2016;16:819–27. Clin Chem Lab Med 2021;59:e362–e6.
30. Wirz Y, Branche A, Wolff M, Welte T, Nobre V, Reinhart K, et al. 44. Yuan S, Zheng N, Zheng W, Jiang Q, Qiao B, Jing H, et al. Analytical
Management of respiratory infections with use of procalcitonin: evaluation of Reebio procalcitonin latex-enhanced
moving toward more personalized antibiotic treatment immunoturbidimetric assay on the HITACHI Labospect 008AS.
decisions. ACS Infect Dis 2017;3:875–9. Clin Chem Lab Med 2020;59:e23–6.
31. Schuetz P, Beishuizen A, Broyles M, Ferrer R, Gavazzi G, Gluck EH, 45. Schuetz P, Christ-Crain M, Huber AR, Muller B. Long-term
et al. Procalcitonin (PCT)-guided antibiotic stewardship: stability of procalcitonin in frozen samples and comparison of
an international experts consensus on optimized clinical use. Kryptor and VIDAS automated immunoassays. Clin Biochem
Clin Chem Lab Med 2019;57:1308–18. 2010;43:341–4.
32. Lee CC, Kwa ALH, Apisarnthanarak A, Feng JY, Gluck EH, Ito A, 46. Huynh HH, Boeuf A, Pfannkuche J, Schuetz P, Thelen M, Nordin G,
et al. Procalcitonin (PCT)-guided antibiotic stewardship in Asia- et al. Harmonization status of procalcitonin measurements: what
828 Schuetz: Procalcitonin to diagnose infections and manage antibiotic treatment

do comparison studies and EQA schemes tell us? Clin Chem Lab 49. Stojanovic I, Schneider JE, Wei L, Hong Z, Keane C, Schuetz P.
Med 2021;59:1610–22. Economic evaluation of procalcitonin-guided antibiotic
47. Eidizadeh A, Asif AR, von Ahsen N, Binder L, Schnelle M. therapy in acute respiratory infections: a Chinese
Differences in procalcitonin measurements between hospital system perspective. Clin Chem Lab Med 2017;55:
three BRAHMS-partnered immunoassays (Liaison, Elecsys and 561–70.
Architect). Clin Chem Lab Med 2019;57:e207–10. 50. Schuetz P, Balk R, Briel M, Kutz A, Christ-Crain M, Stolz D, et al.
48. Chambliss AB, Hayden J, Colby JM. Evaluation of procalcitonin Economic evaluation of procalcitonin-guided antibiotic therapy
immunoassay concordance near clinical decision points. Clin in acute respiratory infections: a US health system perspective.
Chem Lab Med 2019;57:1414–21. Clin Chem Lab Med 2015;53:583–92.