Antimicrobial Stewardship — SCE Infectious Diseases MCQ

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HardAntimicrobial StewardshipAntimicrobial StewardshipSCE Infectious Diseases

A hospital introduces a Procalcitonin (PCT)-guided antibiotic de-escalation protocol for ICU patients with suspected sepsis. In which clinical scenario is PCT least reliable for guiding antibiotic duration?

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Correct answer: D — Infective endocarditis

PCT-guided antibiotic stewardship has been validated in CAP, VAP, and many forms of sepsis. However, PCT is least reliable in localised/deep-seated infections such as endocarditis, osteomyelitis, and undrained abscesses, where PCT may not accurately reflect ongoing infection activity. In endocarditis, treatment duration is protocol-defined (4–6 weeks minimum) and should not be shortened based on PCT kinetics alone. The PRORATA and SAPS trials excluded endocarditis patients.

Reference: NICE NG51 2016 – Sepsis; ProCALP 2023 – Procalcitonin stewardship