Procalcitonin and Presepsin in Gram-Negative Sepsis: Diagnostic, Prognostic, and Antimicrobial Stewardship Perspectives

Because delayed pathogen identification and antibiotic susceptibility testing might delay effective treatment, sepsis caused by multidrug-resistant Gram-negative bacteria continues to be a significant problem in intensive care units.The clinical usefulness of procalcitonin (PCT) and presepsin as early indicators for Gram-negative sepsis diagnosis, disease severity prediction, treatment response monitoring, and antimicrobial stewardship is assessed in this review.While presepsin provides quick early identification and significant prognostic value, particularly in culture-negative sepsis, PCT is notably useful in distinguishing Gram-negative infections from Gram-positive or fungal etiologies.Before traditional culture findings are available, serial monitoring of both biomarkers may assist in detecting treatment failure, delayed biomarker clearance, and potential multidrug-resistant infections.Confounding variables like burns, trauma, renal failure, surgery, and sterile inflammation must be taken into account during interpretation, though.Rapid molecular diagnostics combined with PCT and presepsin may enhance early treatment choices, lower needless antibiotic exposure, and promote precision-based care for critically ill septic patients.