The role of Procalcitonin in management of pleural infections

Abstract

Introduction: Procalcitonin (PCT) is a highly specific marker of systemic bacterial infection, however its role in guiding the management of pleural infection has not been explored. We investigated its role in the management of this condition.

Methods: Patients with a presentation consistent with pleural infection with either pleural fluid pH<7.2, positive gram stain or bacterial culture or frank pus in the pleural cavity were included. They were managed with chest tube drainage and targeted pleural aspirations as needed. Inflammatory markers including PCT were measured regularly and no change to management was made if PCT levels were improving (regardless of CRP). Patients were referred for surgery if there was a lack of response to treatment. Appropriate antibiotics were given intravenously for one week followed by oral for at least 2 weeks until CRP <50.

Data were collected prospectively on all patients. Patients with an expected survival of <3 months from co-morbidities and those with iatrogenic infections were excluded.

Results: Between December 16 and March 18, 33 patients met our inclusion criteria. PCT levels dropped and sepsis resolved in all patients. Outcomes are listed in Table 1.

Conclusion: PCT appears to be a more useful marker of treatment response for pleural infection. Pleural inflammation may be contributing to fever and elevated CRP leading to unnecessary surgical intervention in some patients.