From the Guidelines
Procalcitonin (PCT) can be a useful biomarker for diagnosing and monitoring necrotizing fasciitis, though it should not be used alone for diagnosis. Elevated PCT levels (typically >2 ng/mL) may suggest necrotizing fasciitis in patients with severe soft tissue infections, with higher levels often correlating with disease severity 1. PCT should be measured at presentation and serially to monitor treatment response, with decreasing levels suggesting effective therapy. However, PCT testing must be used alongside clinical assessment, other laboratory markers (like CRP, WBC count), and imaging studies. The primary value of PCT is its relatively high specificity for bacterial infections and its rapid kinetics, rising within 2-4 hours of infection and declining quickly with successful treatment. While PCT can help differentiate necrotizing fasciitis from less severe soft tissue infections, definitive diagnosis still requires surgical exploration. PCT monitoring may also help guide antibiotic therapy decisions, with persistently elevated levels suggesting the need for surgical intervention or antibiotic adjustment.
Some key points to consider when using PCT for necrotizing fasciitis include:
- PCT levels should be interpreted in the context of clinical presentation and other diagnostic findings 1
- Serial PCT measurements can help monitor treatment response and guide adjustments to antibiotic therapy 1
- PCT is not a substitute for surgical exploration and definitive diagnosis of necrotizing fasciitis 1
- The use of PCT in conjunction with other laboratory markers and clinical assessment can help improve diagnostic accuracy and guide management decisions 1
In terms of specific guidelines, the 2018 WSES/SIS-E consensus conference recommends that PCT monitoring may be useful to guide antimicrobial discontinuation (recommendation 2B) 1. Additionally, the 2021 WSES-AAST guidelines suggest that PCT can be used as part of the diagnostic workup for patients with suspected Fournier’s gangrene, along with other laboratory markers and clinical assessment 1.
Overall, PCT can be a valuable tool in the diagnosis and management of necrotizing fasciitis, but it should be used in conjunction with other diagnostic modalities and clinical assessment to ensure accurate diagnosis and effective treatment. The use of PCT should always prioritize morbidity, mortality, and quality of life as the primary outcome, and treatment decisions should be guided by the most recent and highest quality evidence available 1.
From the Research
Pro Calcitonin for Necrotizing Fasciitis
- There is no direct evidence in the provided studies to support the use of pro calcitonin for necrotizing fasciitis 2, 3, 4, 5, 6.
- The management of necrotizing fasciitis typically involves rapid diagnosis, immediate aggressive surgical management, and extended debridement, as well as broad-spectrum antibiotics and supportive care 2, 3, 5, 6.
- Early diagnosis and prompt treatment are crucial to improve outcomes in patients with necrotizing fasciitis, with mortality rates remaining high due to delayed diagnosis and treatment 3, 5, 6.
- The use of laboratory tests, such as the LRINEC score, can help diagnose and assess the severity of necrotizing fasciitis, but a high index of clinical suspicion remains the most important factor in early diagnosis 5, 6.
- Surgical debridement and repeated debridement are essential components of treatment, with amputation sometimes necessary to control the infection 2, 5.