Point-of-care procalcitonin testing for lower respiratory tract infection in pulmonary outpatient care has limited value

Abstract

Lower respiratory tract infections (LRTI) are frequently the reasons for patients to visit their general practitioners or lung specialists; however, physicians tend to prescribe antibiotics less frequently than necessary. A readily available biomarker could help distinguish between viral and bacterial cause of LRTI. The primary objective of our study was to determine the diagnostic accuracy of point-of-care testing (POCT) of procalcitonin (PCT) in identifying bacterial pneumonia in outpatients with LRTI. All patients aged 18 years or older with signs and symptoms of LRTI who visited a respiratory physician were included in the study and their PCT levels were measured. In 110 patients enrolled in the study, three patients (2.7%) had PCT values above the threshold of 0.25 µg/L without proven bacterial infection, in contrast to seven patients with typical radiological signs of pneumonia without elevated POCT PCT levels. The AUC for PCT for the detection of pneumonia was 0.56 (p=0.685). POCT PCT showed limited specificity and sensitivity in distinguishing pneumonia from bronchitis or exacerbation of chronic respiratory diseases. PCT is a marker of severe bacterial infections and not suitable for milder infections in outpatient care.

Zusammenfassung

Infektionen der unteren Atemwege sind ein häufiger Grund zur Vorstellung beim Allgemeinmediziner oder Pneumologen und führen nicht selten zu einer inadäquaten Antibiotika-Therapie. Ein sofort verfügbarer Biomarker zur Unterscheidung einer viralen von einer bakteriellen Genese des Infektes könnte helfen Antibiotika einzusparen. Das Ziel unserer Studie war die Prüfung der diagnostischen Aussagekraft eines POCT PCT in Bezug auf die bakterielle Pneumonie im ambulanten Setting. Alle erwachsenen Patienten mit Zeichen einer Infektion der unteren Atemwege und Vorstellung beim Pneumologen wurden eingeschlossen. Das PCT wurde mittels Schnelltest gemessen. Von den 110 in die Studie eingeschlossen Patienten wiesen 3 (2,7%) ein erhöhtes PCT (>0,25 µg/L) auf. Keiner von ihnen hatte eine bakterielle Infektion oder wurde mit Antibiotika behandelt. Im Kontrast dazu hatten 7 Patienten mit radiologisch nachgewiesener Pneumonie kein erhöhtes PCT. Die AUC für PCT zur Detektion einer Pneumonie lag bei 0,56, p=0,685. Das POCT PCT zeigte damit nur eine eingeschränkte Sensitivität und Spezifität in der Unterscheidung von Pneumonie zur Bronchitis oder Exazerbation. PCT ist ein Marker für schwere Infektionen und bei eher milden Infektionen, die ambulant behandelt werden können, eingeschränkt hilfreich.

Schlüsselwörter

Procalcitonin - Pneumonie - Schnelltest - Antibiotic Stewardship

Keywords

Procalcitonin - pneumonia - point-of-care testing - antimicrobial stewardship

Publication History

Received: 10 March 2023

Accepted after revision: 12 May 2023

Article published online:
14 June 2023

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