Abstract
The procalcitonin test (PCT) is a useful diagnostic marker of sepsis and has been adopted by the Japanese Health Insurance System. We experienced two cases of peritonitis in whom the antibiotic therapy was decided with real-time PCT measurement. Case1 : An 80-year-old male underwent sub-total colectomy and ileostomy for treatment of toxic megacolon due to ulcerative colitis. His pre-operative serum procalcitonin level was 4.34ng/mL. Postoperative antibiotic therapy was stopped when the serum procalcitonin level decreased to 0.27ng/mL, in spite of a WBC count of 18,000/mm3 and a C-reactive protein (CRP) level of 8 mg/mL on post-operative day (POD) 7. Thereafter, inflammation did not aggregate. However the patient developed aspiration pneumonia on POD 13. The serum procalcitonin level rose again to 10.8ng/mL. Antibiotic therapy was again effective and was stopped when the serum procalcitonin level decreased to 0.14ng/mL in spite of a WBC count of 7,500/mm3 and a CRP level of 5.1mg/mL. Thereafter the patient's course was uneventful. Case2 : a 77-year-old male underwent a Hartmann procedure for an intra-pelvic abscess due to invasive rectal cancer. When the pre-operative serum procalcitonin level of 4.34ng/mL decreased to 0.14ng/mL in spite of a WBC count of 10,800/mm3 and a CRP level of 2.85mg/mL on POD 7, antibiotic therapy was stopped and the patient had a good course thereafter. In future, clinical evaluation for PCT levels in various bacterial infections is needed in Japan. These cases highlight the possibility that the serum procalcitonin level is a novel and useful marker that enables the appropriate indication for antibiotics to be determined in patients with abdominal sepsis.
