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Crit Care. 2018 Aug 15;22(1):191. doi: 10.1186/s13054-018-2125-7.

Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials.

Author information

1
Medical University Department, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland.
2
Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, AP-HP, Paris, France.
3
Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, Paris, France.
4
Département d'Epidémiologie Biostatistique et Recherche Clinique, AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France.
5
Department of Anesthesiology and Intensive Care Medicine, Krankenhaus Dueren, Dueren, Germany.
6
Department of Intensive Care, Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
7
Critical Care Department, Hôpital Raymond Poincaré, Assistance Publique - Hôpitaux de Paris, Garches, France.
8
Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
9
Department of General Intensive Care, University Hospital of Liege, Domaine universitaire de Liège, Liege, Belgium.
10
University Medical Centre, University of Groningen, Groningen, The Netherlands.
11
University Medical Center Utrecht, Utrecht, The Netherlands.
12
Laboratory for Critical Care Research, Critical Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
13
Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
14
Critical Care and Peri-operative Medicine, Monash Health, Melbourne, Australia.
15
Faculty of Medicine Nursing and Health Sciences, School of Clinical Sciences, Monash University, Melbourne, Australia.
16
Elisabeth Tweesteden Hospital, Tilburg, The Netherlands.
17
Medisch Spectrum Twente, Enschede, The Netherlands.
18
VU University Medical Centre, Amsterdam, The Netherlands.
19
Faculty of Medicine, University of Basel, Basel, Switzerland.
20
Medical University Department, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland. schuetzph@gmail.com.
21
Faculty of Medicine, University of Basel, Basel, Switzerland. schuetzph@gmail.com.

Abstract

BACKGROUND:

The clinical utility of serum procalcitonin levels in guiding antibiotic treatment decisions in patients with sepsis remains unclear. This patient-level meta-analysis based on 11 randomized trials investigates the impact of procalcitonin-guided antibiotic therapy on mortality in intensive care unit (ICU) patients with infection, both overall and stratified according to sepsis definition, severity, and type of infection.

METHODS:

For this meta-analysis focusing on procalcitonin-guided antibiotic management in critically ill patients with sepsis of any type, in February 2018 we updated the database of a previous individual patient data meta-analysis which was limited to patients with respiratory infections only. We used individual patient data from 11 trials that randomly assigned patients to receive antibiotics based on procalcitonin levels (the "procalcitonin-guided" group) or the current standard of care (the "controls"). The primary endpoint was mortality within 30 days. Secondary endpoints were duration of antibiotic treatment and length of stay.

RESULTS:

Mortality in the 2252 procalcitonin-guided patients was significantly lower compared with the 2230 control group patients (21.1% vs 23.7%; adjusted odds ratio 0.89, 95% confidence interval (CI) 0.8 to 0.99; p = 0.03). These effects on mortality persisted in a subgroup of patients meeting the sepsis 3 definition and based on the severity of sepsis (assessed on the basis of the Sequential Organ Failure Assessment (SOFA) score, occurrence of septic shock or renal failure, and need for vasopressor or ventilatory support) and on the type of infection (respiratory, urinary tract, abdominal, skin, or central nervous system), with interaction for each analysis being > 0.05. Procalcitonin guidance also facilitated earlier discontinuation of antibiotics, with a reduction in treatment duration (9.3 vs 10.4 days; adjusted coefficient -1.19 days, 95% CI -1.73 to -0.66; p <  0.001).

CONCLUSION:

Procalcitonin-guided antibiotic treatment in ICU patients with infection and sepsis patients results in improved survival and lower antibiotic treatment duration.

KEYWORDS:

Antibiotic stewardship; Meta-analysis; Procalcitonin; Sepsis

PMID:
30111341
PMCID:
PMC6092799
DOI:
10.1186/s13054-018-2125-7
[Indexed for MEDLINE]
Free PMC Article

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