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According to WHO, infectious diseases remain in the top 10 of the most common causes of death worldwide, leading to an excessive consumption of antibiotics, often unnecessarily. Antibiotic stewardship policy aims to identify an useful surrogate marker for the differential diagnosis of the bacterial infections from viral or fungal infections. The aims of this strategy is to restrict the prescriptions of antibiotics in order to reduce morbidity associated with excessive antibiotic treatment, decrease of bacterial resistance and optimize the costs of patient care. Procalcitonin (PCT) has emerged in the early ‘90s as a specific biomarker for bacterial infections. Many clinical studies have shown a correlation between the use of PCT as a diagnostic marker of bacterial sepsis and decrease antibiotic consumption, without a secondary increase in mortality. However, the PCT has a number of limitations regarding sensitivity and specificity. Thus, it may be increased in non-infectious diseases or it may remain at low levels in bacterial infections. Also, PCT cannot replace clinical evaluation and bacteriological tests in facing a patient with suspected infectious disease. This review aims to summarize the available informations so far about pathophysiological mechanisms, biological role and clinical utility of PCT in the diagnostic and treatment algorithm of bacterial infections.

Methods We performed a retrospective study over a period of four years (2007-2010) which included all patients diagnosed and treated for left-sided valve infective endocarditis (IE) in the National Institute for Infectious Diseases “Prof. Dr. Matei Bals”, Bucharest. The main objective of our study was assessing the pathological features and early outcomes of our patients managed conservatively in order to determine the best therapeutic approach.

Methods We performed a retrospective study exclusively on cases of sepsis and severe sepsis, in which we analyzed the records of the patients admitted in our ward last year. We included 131 patients, with a mean age of 64 years. Of all patients admitted to the ICU, 73 died and 74 required mechanical ventilation for a mean duration of over 6 days. These data suggest the seriousness and complexity of the disease. More than 45 patients were diagnosed with sepsis with MSOF (more than 3 organ dysfunctions).