Clinical impact of procalcitonin-based algorithms for duration of antibiotic treatment in critically ill adult patients with sepsis: a meta-analysis of randomized clinical trials

Gutiérrez‐Pizarraya, Antonio; León-García, María Del Carmen; Juan-Idígoras, Reyes De; Garnacho-Montero, José

doi:10.1080/14787210.2021.1932462

Cited by 12 publications

(22 citation statements)

References 41 publications

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“…Interestingly, some meta-analyses support that PCT-guidance is associated with decreased antimicrobial consumption and mortality only if cessation algorithms are applied [58]. A summary of published meta-analyses evaluating PCT-guidance is presented in Table 3 [54][55][56][57][58][59][60][61][62][63][64][65][66]. Abbreviations: CI-confidence interval; GFR-glomerular filtration rate; IPD-individual patient data; NA-non applicable; OR-odds ratio; PCT-procalcitonin; RR-risk ratio.…”

Section: Antimicrobial Stewardship Through Pct-guidance In Sepsismentioning

confidence: 99%

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Kyriazopoulou

Giamarellos‐Bourboulis

2022

Antibiotics

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This review aims to summarize current progress in the management of critically ill, using biomarkers as guidance for antimicrobial treatment with a focus on antimicrobial stewardship. Accumulated evidence from randomized clinical trials (RCTs) and observational studies in adults for the biomarker-guided antimicrobial treatment of critically ill (mainly sepsis and COVID-19 patients) has been extensively searched and is provided. Procalcitonin (PCT) is the best studied biomarker; in the majority of randomized clinical trials an algorithm of discontinuation of antibiotics with decreasing PCT over serial measurements has been proven safe and effective to reduce length of antimicrobial treatment, antibiotic-associated adverse events and long-term infectious complications like infections by multidrug-resistant organisms and Clostridioides difficile. Other biomarkers, such as C-reactive protein and presepsin, are already being tested as guidance for shorter antimicrobial treatment, but more research is needed. Current evidence suggests that biomarkers, mainly procalcitonin, should be implemented in antimicrobial stewardship programs even in the COVID-19 era, when, although bacterial coinfection rate is low, antimicrobial overconsumption remains high.

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Section: Antimicrobial Stewardship Through Pct-guidance In Sepsismentioning

confidence: 99%

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Kyriazopoulou

Giamarellos‐Bourboulis

2022

Antibiotics

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“… 9 Though baseline serum PCT is a sensitive marker for sepsis diagnosis, inherent limitations preclude recommendations for its use in initial diagnosis and decision-making regarding antibiotic initiation. 10 – 13 Majority of RCTs evaluating PCT-based algorithms to decide the duration of antibiotic treatment in critically ill sepsis patients have used both absolute values and 80% reduction from baseline. 7 , 13 Though not recommended for antibiotic initiation, baseline PCT levels shall be required for antibiotic cessation if criteria utilizing percentage decline from baseline value are utilized.…”

Section: Pct In S Epsismentioning

confidence: 99%

Guidelines for the Use of Procalcitonin for Rational Use of Antibiotics

Chaudhry¹,

Sharma²,

Govil³

et al. 2022

Indian Journal of Critical Care Medicine

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“…In 2021, Antoni et al compiled additional studies published in 2017 and 2018 to evaluate the effect of using the PCT algorithm in determining the duration of antibiotics use in adult patients with sepsis [ 151 ]. They included 12 articles.…”

Section: Introductionmentioning

confidence: 99%

Current Status of Antibiotic Stewardship and the Role of Biomarkers in Antibiotic Stewardship Programs

Kim

2022

Infect Chemother

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The importance of antibiotic stewardship is increasingly emphasized in accordance with the increasing incidences of multidrug-resistant organisms and accompanying increases in disease burden. This review describes the obstacles in operating an antibiotic stewardship program (ASP), and whether the use of biomarkers within currently available resources can help. Surveys conducted around the world have shown that major obstacles to ASPs are shortages of time and personnel, lack of appropriate compensation for ASP operation, and lack of guidelines or appropriate manuals. Sufficient investment, such as the provision of full-time equivalent ASP practitioners, and adoption of computerized clinical decision systems are useful measures to improve ASP within an institution. However, these methods are not easy in terms of both time commitments and cost. Some biomarkers, such as C-reactive protein, procalcitonin, and presepsin are promising tools in ASP due to their utility in diagnosis and forecasting the prognosis of sepsis. Recent studies have demonstrated the usefulness of algorithmic approaches based on procalcitonin level to determine the initiation or discontinuation of antibiotics, which would be helpful in decreasing antibiotics use, resulting in more appropriate antibiotics use.

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Clinical impact of procalcitonin-based algorithms for duration of antibiotic treatment in critically ill adult patients with sepsis: a meta-analysis of randomized clinical trials

Cited by 12 publications

References 41 publications

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Antimicrobial Stewardship Using Biomarkers: Accumulating Evidence for the Critically Ill

Guidelines for the Use of Procalcitonin for Rational Use of Antibiotics

Current Status of Antibiotic Stewardship and the Role of Biomarkers in Antibiotic Stewardship Programs

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