It’s exciting to see that we have such a lively discussion underway!
Dr. Cutrell brings up an interesting point about the chosen study population. It seems that much of the recent literature on procalcitonin has centered on critically ill patients. A growing body of work (linked below) is supporting the use of procalcitonin in the ICU setting. This study appears to be one of the few investigating procalcitonin in the ED. Considering that decisions about starting antibiotics are often made in the ED, we need to know if procalcitonin has a role in preventing needless antibiotic use in this setting. Of course, the ED captures a wider gamut of illness severity including floor patients and those who do not require admission. Apparently procalcitonin also correlates with the severity of illness. As table S2 shows, only about 47% of patients were hospitalized. Less than 5% of patients were admitted to the ICU (Table S6).
Dr. Alvarez Concejo brings up the importance of appropriate antibiotic use in the primary care setting. It will be interesting to see if procalcitonin has the same utility in outpatient practice.
The results of this study reflects a population that is not as sick. Perhaps procalcitonin is less helpful among patients with minor bacterial infections who are not critically ill.
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