Justificación de la Aplicación Práctica de la Procalcitonina en Adultos Sépticos Hospitalizados. Revisión bibliográfica
Palabras clave:
polipéptido alfa relacionado con calcitonina, infecciones, biomarcadores, sepsis, terapéutica
Resumen
Introducción: La procalcitonina (PCT) es una proteína precedente de la hormona calcitonina, se ha convertido en un biomarcador prometedor para evaluar la presencia de infecciones bacterianas y la gravedad en pacientes con sepsis; la Sociedad de enfermedades infecciosas de América refiere que la procalcitonina es útil para diferenciar el agente causal de la infección, siendo útil para la monitorización más no para el empleo terapéutico. Objetivo: Establecer la aplicación práctica de la procalcitonina en pacientes sépticos hospitalizados de etiología bacteriana mediante una revisión bibliográfica para el empleo de la terapia antibiótica. Metodología: Investigación con paradigma positivista de enfoque cuantitativo, tipo básico, diseño no experimental, modalidad documental y metodología interpretativa, aplicando criterios de inclusión y operadores booleanos un total de 60 revisiones bibliográficas provenientes de Pubmed, Elsevier y Scielo usando la metodología PRISMA. Resultados y Discusión: Existe aplicación práctica de la PCT en pacientes sépticos hospitalizados, esto se evidenció debido que a la mayoría de los pacientes se les realizó un examen de PCT al inicio de su estancia hospitalaria encontrando su utilidad para el manejo antibiótico sin embargo no se encontraron guías que justifiquen su uso. Conclusión: se evidencia que no existe una justificación de la aplicación práctica de la procalcitonina en el manejo del paciente séptico, su utilidad es poca y se encuentra escasamente demostrada, sin embargo, las inclinaciones de su uso son varias y se requieren más estudios para poder emitir una postura clara sobre su utilidad.
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1. Hamade B, Huang DT. Procalcitonin: Where Are We Now? Crit Care Clin [Internet]. 2020;36(1):23–40. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6866676/
2. Xu H-G, Tian M, Pan S-Y. Clinical utility of procalcitonin and its association with pathogenic microorganisms. Crit Rev Clin Lab Sci [Internet]. 2022;59(2):93–111. Available from: https://www.tandfonline.com/doi/full/10.1080/10408363.2021.1988047
3. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia. Am J Respir Crit Care Med [Internet]. 2019 Oct 1 [cited 2024 Feb 21];200(7):E45–67. Available from: https://www.atsjournals.org/doi/full/10.1164/rccm.201908-1581ST
4. Schuetz P. How to best use procalcitonin to diagnose infections and manage antibiotic treatment. Clin Chem Lab Med [Internet]. 2023;61(5):822–8. Available from: https://www.degruyter.com/document/doi/10.1515/cclm-2022-1072/html
5. Paudel R, Dogra P, Montgomery-Yates AA, Yataco AC. Procalcitonin: A promising tool or just another overhyped test? Int J Med Sci [Internet]. 2020 [cited 2023 Dec 19];17(3):332–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053349/
6. Kim JH. Clinical Utility of Procalcitonin on Antibiotic Stewardship: A Narrative Review [Internet]. Vol. 54, Infection and Chemotherapy. Korean Society of Infectious Diseases, Korean Society for Antimicrobial Therapy, Korean Society for AIDS; 2022. p. 610–20. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840962/
7. Brenon JR, Shulder SE, Munsiff SS, Burgoyne CM, Nagel AK, Pillinger KE. Rate of broad-spectrum antibiotic overuse in patients receiving outpatient parenteral antibiotic therapy (OPAT). Antimicrob Steward Healthc Epidemiol [Internet]. 2021;1(1):1–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495413/
8. Mellado-Orellana R, Ortega-Chavarria MJ, Guerrero-Giron A, Diaz-Greene EJ, Rodriguez-Weber FL. Procalcitonin updates. Med Interna Mex [Internet]. 2021;37(1):110–5. Available from: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=98479
9. Huespe I, Prado E, Staneloni I, Contrera N, Denaday L, Roman ES, et al. Kinetics of procalcitonin in infections caused by multidrug-resistant bacteria. Medicina (B Aires) [Internet]. 2020;80(6):599–605. Available from: https://pubmed.ncbi.nlm.nih.gov/33254103/
10. Sartelli M, Ansaloni L, Bartoletti M, Catena F, Cardi M, Cortese F, et al. The role of procalcitonin in reducing antibiotics across the surgical pathway. World J Emerg Surg [Internet]. 2021;16(1):1–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988639/
11. Abril FM, Mendez Fandiño Y, Herrera-Amaya G, Rodriguez J, Manrique-Abril R. Uso de procalcitonina como diagnóstico de sepsis o shock séptico: revisión sistemática y metaanálisis. 2019 [cited 2024 Feb 21];23(2). Available from: https://revistainfectio.org/P_OJS/index.php/infectio/article/view/769
12. C. Raffo C JMABDOAMHNDPMBA. USO DE PROCALCITONINA COMO ESTUDIOCOMPLEMENTARIO EN EL DIAGNOSTICODE INFECCIONES BACTERIANAS EN UNHOSPITAL DE AGUDOS [Internet]. 2017 [cited 2024 Feb 21]. Available from: https://infectologia.info/abstracts/uso-de-procalcitonina-como-estudio-complementario-en-el-diagnostico-de-infecciones-bacterianas-en-un-hospital-de-agudos/
13. Weiss E, Zahar JR, Lesprit P, Ruppe E, Leone M, Chastre J, et al. Elaboration of a consensual definition of de-escalation allowing a ranking of β-lactams. Clin Microbiol Infect [Internet]. 2015;21(7):649.e1-649.e10. Available from: https://pubmed.ncbi.nlm.nih.gov/25882363/#:~:text=According to our consensus definition,gradation of DE was established.
14. García-Lamberechts EJ, González-del Castillo J, Hormigo-Sánchez AI, Núñez-Orantos MJ, Candel FJ, Martín-Sánchez FJ. Factors predicting failure in empirical antibiotic treatment. An Sist Sanit Navar [Internet]. 2017;40(1):119–30. Available from: https://scielo.isciii.es/pdf/asisna/v40n1/1137-6627-asisna-40-01-00119.pdf
15. Arancibia JM. Strategies for the Use of Antimicrobials in Seriously Ill Patients. Rev Medica Clin Las Condes [Internet]. 2019;30(2):151–9. Available from: https://www.sciencedirect.com/science/article/pii/S0716864019300197
16. Cook MA, Wright GD. The past, present, and future of antibiotics. Sci Transl Med [Internet]. 2022;14(657):1–12. Available from: https://www.science.org/doi/10.1126/scitranslmed.abo7793?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr _pub 0pubmed
17. Kolář M. Bacterial Infections, Antimicrobial Resistance and Antibiotic Therapy. Life [Internet]. 2022;12(4):10–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9027052/
18. Mesquita MN, Godoy LE, Kabboutt HA, Servin ML. Antibiotic escalation with the inclusion of a checklist in the pediatric intensive care unit. Rev Chil Infectol [Internet]. 2020;37(4):349–55. Available from: https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182020000400349
19. Boudma L, Luyt CE, Tubach F, Cracco C, Álvarez A, Schwebel C, et al. Uso de procalcitonina para reducir la exposición de los pacientes a antibióticos en unidades de cuidados intensivos (ensayo PRORATA): un ensayo controlado aleatorio multicéntrico. Lanceta [Internet]. 2010;375(9713):463–74. Available from: https://pubmed.ncbi.nlm.nih.gov/20097417/
20. Assink-de Jong E, de Lange DW, van Oers JA, Nijsten MW, Twisk JW, Beishuizen A. Stop Antibiotics on guidance of Procalcitonin Study (SAPS): A randomised prospective multicenter investigator-initiated trial to analyse whether daily measurements of procalcitonin versus a standard-of-care approach can safely shorten antibiotic duration. BMC Infect Dis [Internet]. 2013;13(1):1471–2334. Available from: https://pubmed.ncbi.nlm.nih.gov/23590389/
21. Shajiei A, Berends MS, Luz CF, van Oers JA, Harmsen HJM, Vos P, et al. Impact of reduced antibiotic treatment duration on antimicrobial resistance in critically ill patients in the randomized controlled SAPS-trial. Front Med [Internet]. 2023;10. Available from: https://www.frontiersin.org/articles/10.3389/fmed.2023.1080007/full
22. Westwood M, Ramaekers B, Whiting P, Tomini F, Joore M, Armstrong N, et al. Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: A systematic review and cost-effectiveness analysis. Health Technol Assess (Rockv) [Internet]. Nov [cited 2023 Dec 19];19(96):3–236. Available from: https://www.journalslibrary.nihr.ac.uk/hta/hta19960/#/abstract
23. Contenti J, Julián Jiménez A, Occelli C, Lemoel F, Ferrari P, Levraut J. Capacidad diagnóstica de presepsina comparada con otros biomarcadores para predecir sepsis y shock séptico en pacientes con infección siguiendo la definición Sepsis-3. Rev Cient la Soc Española Med Urgenc y Emergencias [Internet]. 2019;31:311–7. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/ibc-184120
24. Al-Nawas’ B, Shah2 P 211. Procalcitonin, a new diagnostic and prognostic marker for severe infections. In: Clinical Microbiology and Infection [Internet]. [cited 2023 Dec 19]. Available from: https://www.sciencedirect.com/science/article/pii/S1198743X14650369
25. Aloisio E, Dolci A, Panteghini M. Procalcitonin: Between evidence and critical issues. Clin Chim Acta [Internet]. 2019;496(June):7–12. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0009898119319023?via%3Dihub
26. Zhang Y, Zhang J, Zhao L, Zhao N, Zhang Y, Zhang J, et al. Procalcitonin in infectious diseases: A bibliometric analysis. Ann Palliat Med [Internet]. 2021;10(7):8003–14. Available from: https://pubmed.ncbi.nlm.nih.gov/34353085/
27. VELISSARIS D, ZAREIFOPOULOS N, LAGADINOU M, PLATANAKI C, TSIOTSIOS K, STAVRIDIS E.L, et al. Procalcitonin and sepsis in the EmergencyDepartment: an update. 2021 [cited 2024 Feb 21]; Available from: https://pubmed.ncbi.nlm.nih.gov/33506938/
28. Willmon J, Subedi B, Girgis R, Noe M. Impact of Pharmacist-Directed Simplified Procalcitonin Algorithm on Antibiotic Therapy in Critically Ill Patients With Sepsis. Hosp Pharm [Internet]. 2021;56(5):501–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554589/
2. Xu H-G, Tian M, Pan S-Y. Clinical utility of procalcitonin and its association with pathogenic microorganisms. Crit Rev Clin Lab Sci [Internet]. 2022;59(2):93–111. Available from: https://www.tandfonline.com/doi/full/10.1080/10408363.2021.1988047
3. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia. Am J Respir Crit Care Med [Internet]. 2019 Oct 1 [cited 2024 Feb 21];200(7):E45–67. Available from: https://www.atsjournals.org/doi/full/10.1164/rccm.201908-1581ST
4. Schuetz P. How to best use procalcitonin to diagnose infections and manage antibiotic treatment. Clin Chem Lab Med [Internet]. 2023;61(5):822–8. Available from: https://www.degruyter.com/document/doi/10.1515/cclm-2022-1072/html
5. Paudel R, Dogra P, Montgomery-Yates AA, Yataco AC. Procalcitonin: A promising tool or just another overhyped test? Int J Med Sci [Internet]. 2020 [cited 2023 Dec 19];17(3):332–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053349/
6. Kim JH. Clinical Utility of Procalcitonin on Antibiotic Stewardship: A Narrative Review [Internet]. Vol. 54, Infection and Chemotherapy. Korean Society of Infectious Diseases, Korean Society for Antimicrobial Therapy, Korean Society for AIDS; 2022. p. 610–20. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840962/
7. Brenon JR, Shulder SE, Munsiff SS, Burgoyne CM, Nagel AK, Pillinger KE. Rate of broad-spectrum antibiotic overuse in patients receiving outpatient parenteral antibiotic therapy (OPAT). Antimicrob Steward Healthc Epidemiol [Internet]. 2021;1(1):1–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9495413/
8. Mellado-Orellana R, Ortega-Chavarria MJ, Guerrero-Giron A, Diaz-Greene EJ, Rodriguez-Weber FL. Procalcitonin updates. Med Interna Mex [Internet]. 2021;37(1):110–5. Available from: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=98479
9. Huespe I, Prado E, Staneloni I, Contrera N, Denaday L, Roman ES, et al. Kinetics of procalcitonin in infections caused by multidrug-resistant bacteria. Medicina (B Aires) [Internet]. 2020;80(6):599–605. Available from: https://pubmed.ncbi.nlm.nih.gov/33254103/
10. Sartelli M, Ansaloni L, Bartoletti M, Catena F, Cardi M, Cortese F, et al. The role of procalcitonin in reducing antibiotics across the surgical pathway. World J Emerg Surg [Internet]. 2021;16(1):1–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7988639/
11. Abril FM, Mendez Fandiño Y, Herrera-Amaya G, Rodriguez J, Manrique-Abril R. Uso de procalcitonina como diagnóstico de sepsis o shock séptico: revisión sistemática y metaanálisis. 2019 [cited 2024 Feb 21];23(2). Available from: https://revistainfectio.org/P_OJS/index.php/infectio/article/view/769
12. C. Raffo C JMABDOAMHNDPMBA. USO DE PROCALCITONINA COMO ESTUDIOCOMPLEMENTARIO EN EL DIAGNOSTICODE INFECCIONES BACTERIANAS EN UNHOSPITAL DE AGUDOS [Internet]. 2017 [cited 2024 Feb 21]. Available from: https://infectologia.info/abstracts/uso-de-procalcitonina-como-estudio-complementario-en-el-diagnostico-de-infecciones-bacterianas-en-un-hospital-de-agudos/
13. Weiss E, Zahar JR, Lesprit P, Ruppe E, Leone M, Chastre J, et al. Elaboration of a consensual definition of de-escalation allowing a ranking of β-lactams. Clin Microbiol Infect [Internet]. 2015;21(7):649.e1-649.e10. Available from: https://pubmed.ncbi.nlm.nih.gov/25882363/#:~:text=According to our consensus definition,gradation of DE was established.
14. García-Lamberechts EJ, González-del Castillo J, Hormigo-Sánchez AI, Núñez-Orantos MJ, Candel FJ, Martín-Sánchez FJ. Factors predicting failure in empirical antibiotic treatment. An Sist Sanit Navar [Internet]. 2017;40(1):119–30. Available from: https://scielo.isciii.es/pdf/asisna/v40n1/1137-6627-asisna-40-01-00119.pdf
15. Arancibia JM. Strategies for the Use of Antimicrobials in Seriously Ill Patients. Rev Medica Clin Las Condes [Internet]. 2019;30(2):151–9. Available from: https://www.sciencedirect.com/science/article/pii/S0716864019300197
16. Cook MA, Wright GD. The past, present, and future of antibiotics. Sci Transl Med [Internet]. 2022;14(657):1–12. Available from: https://www.science.org/doi/10.1126/scitranslmed.abo7793?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr _pub 0pubmed
17. Kolář M. Bacterial Infections, Antimicrobial Resistance and Antibiotic Therapy. Life [Internet]. 2022;12(4):10–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9027052/
18. Mesquita MN, Godoy LE, Kabboutt HA, Servin ML. Antibiotic escalation with the inclusion of a checklist in the pediatric intensive care unit. Rev Chil Infectol [Internet]. 2020;37(4):349–55. Available from: https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0716-10182020000400349
19. Boudma L, Luyt CE, Tubach F, Cracco C, Álvarez A, Schwebel C, et al. Uso de procalcitonina para reducir la exposición de los pacientes a antibióticos en unidades de cuidados intensivos (ensayo PRORATA): un ensayo controlado aleatorio multicéntrico. Lanceta [Internet]. 2010;375(9713):463–74. Available from: https://pubmed.ncbi.nlm.nih.gov/20097417/
20. Assink-de Jong E, de Lange DW, van Oers JA, Nijsten MW, Twisk JW, Beishuizen A. Stop Antibiotics on guidance of Procalcitonin Study (SAPS): A randomised prospective multicenter investigator-initiated trial to analyse whether daily measurements of procalcitonin versus a standard-of-care approach can safely shorten antibiotic duration. BMC Infect Dis [Internet]. 2013;13(1):1471–2334. Available from: https://pubmed.ncbi.nlm.nih.gov/23590389/
21. Shajiei A, Berends MS, Luz CF, van Oers JA, Harmsen HJM, Vos P, et al. Impact of reduced antibiotic treatment duration on antimicrobial resistance in critically ill patients in the randomized controlled SAPS-trial. Front Med [Internet]. 2023;10. Available from: https://www.frontiersin.org/articles/10.3389/fmed.2023.1080007/full
22. Westwood M, Ramaekers B, Whiting P, Tomini F, Joore M, Armstrong N, et al. Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: A systematic review and cost-effectiveness analysis. Health Technol Assess (Rockv) [Internet]. Nov [cited 2023 Dec 19];19(96):3–236. Available from: https://www.journalslibrary.nihr.ac.uk/hta/hta19960/#/abstract
23. Contenti J, Julián Jiménez A, Occelli C, Lemoel F, Ferrari P, Levraut J. Capacidad diagnóstica de presepsina comparada con otros biomarcadores para predecir sepsis y shock séptico en pacientes con infección siguiendo la definición Sepsis-3. Rev Cient la Soc Española Med Urgenc y Emergencias [Internet]. 2019;31:311–7. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/ibc-184120
24. Al-Nawas’ B, Shah2 P 211. Procalcitonin, a new diagnostic and prognostic marker for severe infections. In: Clinical Microbiology and Infection [Internet]. [cited 2023 Dec 19]. Available from: https://www.sciencedirect.com/science/article/pii/S1198743X14650369
25. Aloisio E, Dolci A, Panteghini M. Procalcitonin: Between evidence and critical issues. Clin Chim Acta [Internet]. 2019;496(June):7–12. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0009898119319023?via%3Dihub
26. Zhang Y, Zhang J, Zhao L, Zhao N, Zhang Y, Zhang J, et al. Procalcitonin in infectious diseases: A bibliometric analysis. Ann Palliat Med [Internet]. 2021;10(7):8003–14. Available from: https://pubmed.ncbi.nlm.nih.gov/34353085/
27. VELISSARIS D, ZAREIFOPOULOS N, LAGADINOU M, PLATANAKI C, TSIOTSIOS K, STAVRIDIS E.L, et al. Procalcitonin and sepsis in the EmergencyDepartment: an update. 2021 [cited 2024 Feb 21]; Available from: https://pubmed.ncbi.nlm.nih.gov/33506938/
28. Willmon J, Subedi B, Girgis R, Noe M. Impact of Pharmacist-Directed Simplified Procalcitonin Algorithm on Antibiotic Therapy in Critically Ill Patients With Sepsis. Hosp Pharm [Internet]. 2021;56(5):501–6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554589/
Publicado
2025-08-14
Cómo citar
Patiño Pineda, C. P., Díaz Orellana, A. M., & Briones Morales, V. E. (2025). Justificación de la Aplicación Práctica de la Procalcitonina en Adultos Sépticos Hospitalizados. Revisión bibliográfica. Ciencia Latina Revista Científica Multidisciplinar, 9(4), 2290-2303. Recuperado a partir de https://ciencialatina.org/index.php/cienciala/article/view/18820
Número
Sección
Ciencias de la Salud
Derechos de autor 2025 Carlos Paul Patiño Pineda, Allison Michelle Díaz Orellana, Victor Euclides Briones Morales
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
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