Skytorial on my take on the ADAPT trial 😀
But first: my general philosophy on PCT.
There are roughly two uses of PCT:
[1] Initial diagnosis of infection (usually: sepsis/PNA).
[2] Tracking procal to determine length of ABX.
🧵 #1/6
But first: my general philosophy on PCT.
There are roughly two uses of PCT:
[1] Initial diagnosis of infection (usually: sepsis/PNA).
[2] Tracking procal to determine length of ABX.
🧵 #1/6
Comments
'[1] Initial diagnosis of infection (usually: sepsis/PNA).
[2] Tracking procal to determine length of ABX'
Sometimes PCT helps debunk an incorrect diagnosis (e.g., atelectasis or heart failure mis-diagnosed as PNA).
That's a BIG WIN for the patient: stop ABX & redirect treatment at the real problem.
🧵 #2/6
The reasons we use too much ABX:
🐌 people aren't up-to-date on modern evidence regarding ABX tx duration (shorter is better)
🐌 we don't deescalate (eg keep on vanc despite neg MRSA PCR)
A billion PCTs won't help this.
🧵 #3/6
Docs couldn't see the procalcitonin values.
High PCT values freak people out.
The study design forced people to use a protocol. In reality, we're often bad at that.
🧵 #4/6
For example: you're treating PNA for 7 days, pt is getting better, but the PCT is still scary high... maybe you should keep ABX on?
🧵 #5/6
- I think PCT values can be diagnostically helpful in murky cases (when integrated with clinical judgment).
- I don't think daily PCT will help.
- We need to do better about time-limiting our ABX & de-escalation.
🧵 #6/6
It's a little tough, but once you *start* with looking at kinetics rather than absolutes, you quickly realize that it actually works.
But, after all, we need to change how people THINK about CRP/Pct and whatnot. And that takes a lot of time.