Uloga prokalcitonina u ordiniranju antibiotske terapije
DOI:
https://doi.org/10.13112/pc.1158Ključne riječi:
Vrućica; Prokalcitonin; Infekcije; AntibioticiSažetak
Razlikovanje benignih virusnih bolesti od ozbiljnih bakterijskih infekcija (SBI) i dalje je izazovno u liječenju pedijatrijskih bolesnika. Mlađa febrilna dojenčad, osobito ona dobi ≤90 dana, imaju nerazmjerno visok rizik od invazivnih bakterijskih infekcija (IBI) zbog imunološke nezrelosti i suptilnih kliničkih prezentacija. S obzirom na rastuću antimikrobnu rezistenciju, postoji potreba za pouzdanim biomarkerima koji će doprinijeti ranom i točnom postavljanju dijagnoze. Prokalcitonin (PCT), biomarker akutne faze s brzim porastom tijekom bakterijske infekcije, istaknuo se kao jedan od najperspektivnijih alata. U usporedbi s C-reaktivnim proteinom (CRP), PCT pokazuje bržu kinetiku, jaču povezanost s težinom bolesti i bolju dijagnostičku točnost u brojnim pedijatrijskim stanjima, uključujući neonatalnu sepsu, febrilnu dojenčad, neutropeniju, meningitis, bronhiolitis i infekcije donjih dišnih putova. Dobno specifični referentni rasponi poboljšavaju interpretaciju u novorođenčadi, a serijska mjerenja PCT-a uspješno su uključena u protokole racionalne primjene antibiotika. Brojne multicentrične studije i randomizirana ispitivanja pokazuju da vođenje terapije prema PCT-u smanjuje nepotrebnu izloženost antibioticima bez ugrožavanja kliničke sigurnosti ili povećanja neuspjeha liječenja. Unatoč prednostima, PCT ima i ograničenja, jer se prolazna povišenja mogu javiti u neinfektivnim stanjima, a razine mogu ostati niske u najranijim fazama infekcije. Ipak, sve veći broj dokaza pokazuje da niske vrijednosti PCT-a pouzdano upućuju na malu vjerojatnost bakterijske infekcije, omogućujući sigurnije smanjenje primjene antibiotika. Sveukupno, PCT predstavlja vrijedan biomarker za poboljšanje dijagnostičke točnosti i promicanje racionalne antibiotske terapije u pedijatrijskoj praksi.
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