This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Procalcitonin in bacteraemia

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • procalcitonin is a prohormone of calcitonin that has been reported to be present in increased levels in the blood of infected patients
  • the ability to accurately and rapidly identify patients with bacteraemia is an important management issue for emergency physicians
    • a potential use of the procalcitonin test in the emergency department (ED) is as a screening test for bacteraemia
      • young children are often unable to localize their infection and the management, disposition, and prognosis all change according to the presence or absence of bacteraemia
      • in adults, approximately 50% of patients evaluated in the ED with undifferentiated hypotension or hypotension of uncertain cause are ultimately diagnosed with sepsis
  • a systematic review investigated the test characteristics of procalcitonin as a marker for bacteraemia (1)
    • the authors found the diagnostic performance of the procalcitonin test for identifying bacteremia in ED patients to be moderate
  • however
    • an individual study in patients with exacerbations of COPD revealed evidence for the use of the test in identifying patients who required antibiotic treatment (2)
      • the study included 208 patients randomized at the index exacerbation to procalcitonin-guided or standard antibiotic therapy
        • patients receiving procalcitonin-guided therapy were treated with antibiotics according to serum procalcitonin levels; standard-therapy patients received antibiotics according to the attending physician
      • procalcitonin guidance reduced antibiotic prescription (40% vs 72%, respectively; p < 0.0001) and antibiotic exposure (relative risk [RR], 0.56; 95% confidence interval [CI], 0.43 to 0.73; p < 0.0001) compared to standard therapy
      • procalcitonin guidance at the index exacerbation allowed a significant sustained reduction in total antibiotic exposure for up to 6 months (RR, 0.76; 95% CI, 0.64 to 0.92; p = 0.004)
      • the authors concluded that procalcitonin guidance for exacerbations of COPD offers a sustained advantage over standard therapy in reducing antibiotic use for up to 6 months with a number-needed-to-treat of 3
    • a systematic review investigated the accuracy of serum procalcitonin as a diagnostic test for sepsis, severe sepsis, or septic shock in adults in intensive care units or after surgery or trauma, alone and compared with C-reactive protein (3)
      • the study authors concluded that procalcitonin represents a good biological diagnostic marker for sepsis, severe sepsis, or septic shock, difficult diagnoses in critically ill patients. Based on the study resulst, procalcitonin was superior to C-reactive protein

    • a randomized controlled trial investigated the use of procalcitonin level-guided treatment in exacerbations of COPD (4)
      • the study revealed that procalcitonin guidance for exacerbations of COPD offered a sustained advantage over standard therapy in reducing antibiotic use for up to 6 months with a number-needed-to-treat of 3

    • a randomized controlled trial in primary care relating to the treatment of acute respiratory tract infection (5):
      • revealed that procalcitonin-guided therapy markedly reduces antibiotic use for acute respiratory tract infections in primary care without compromising patient outcome
      • authors suggest that procalcitonin-guided therapy could be achieved with 1 to 2 procalcitonin measurements in patients for whom the physician intends to prescribe antibiotics

    • evidence shows that procalcitonin-guided care can reduce antibiotic use without increasing infection or harm in patients with acute pancreatitis (6)


  1. Jones AE et al. Procalcitonin Test in the Diagnosis of Bacteremia: A Meta-analysis.Ann Emerg Med. 2006 Dec 8.
  2. Stolz D et al. Antibiotic Treatment of Exacerbations of COPD: A Randomized, Controlled Trial Comparing Procalcitonin-Guidance With Standard Therapy. Chest. 2007 Jan;131(1):9-19
  3. Uzzan B et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med. 2006 Jul;34(7):1996-2003.
  4. Stolz D et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest. 2007 Jan;131(1):9-19.
  5. Briel M et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Intern Med. 2008 Oct 13;168(18):2000-7; discussion 2007-8
  6. Siriwardena A et al. A procalcitonin-based algorithm to guide antibiotic use in patients with acute pancreatitis (PROCAP): a single-centre, patient-blinded, randomised controlled trial . Lancet Gastroenterology & Hepatology 2022 DOI:

Create an account to add page annotations

Add information to this page that would be handy to have on hand during a consultation, such as a web address or phone number. This information will always be displayed when you visit this page

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.


Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.