Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: A systematic review and meta-analysis of randomized controlled trials

Kopterides, Petros; Siempos, Ilias I.; Tsangaris, Iraklis; Tsantes, Argirios Ε.; Armaganidis, Apostolos

doi:10.1097/ccm.0b013e3181f17bf9

Cited by 228 publications

(139 citation statements)

References 46 publications

Supporting

Mentioning

117

Contrasting

Unclassified

Order By: Relevance

“…Since the trials that we evaluated enrolled patients with respiratory tract infections ranging from acute bronchitis to ventilation-associated pneumonia, differences in disease severity and variability in comorbidities in enrolled patients might partly explain the heterogeneity, along with differences in the PCT-guided treatment algorithms. In addition to our study and the report by Tang et al (35), another recently reported meta-analysis regarding PCTguided antibiotic therapy in the ICU also showed a high degree of heterogeneity (17). Similar to the pooled analysis of PCT-guided antibiotic therapy among ICU patients (17), the pooled data in our analysis indicate that PCT-guided therapy is safe without compromising clinical outcomes.…”

Section: Discussionsupporting

confidence: 75%

Meta-Analysis and Systematic Review of Procalcitonin-Guided Therapy in Respiratory Tract Infections

Luo

Blackwell

et al. 2011

Antimicrob Agents Chemother

View full text Add to dashboard Cite

Circulating procalcitonin (PCT) is a biomarker that can be used in diagnosing bacterial infections. We performed a quantitative meta-analysis of available randomized controlled trials to determine whether antibiotic therapy based on PCT measurements alters clinical outcomes and antibiotic use in patients with lower respiratory tract infections. We identified studies through MEDLINE (1996 to 2010), the ISI Web of Knowledge (1996 to 2010), and Ovid. Studies that met our criteria were prospective, randomized controlled trials involving patients with respiratory tract infections. Outcomes of mortality, intensive care unit (ICU) admission, length of hospital stay, number of antibiotic prescriptions, and duration of antibiotic treatment were evaluated. Eight studies randomizing 3,431 patients met our criteria for inclusion. Pooled analysis showed a significant reduction in number of antibiotic prescriptions and duration of antibiotic use in patients with PCT-guided antibiotic treatment compared to standard therapy. In addition, the use of PCT-guided antibiotic therapy did not impact mortality, ICU admission, or length of hospital stay in these studies. A high degree of heterogeneity was identified in 3 of 5 outcomes that were evaluated, and sensitivity analysis indicated that heterogeneity was decreased among studies using the same PCT-based treatment algorithm. In conclusion, PCT-guided antibiotic therapy in patients with respiratory tract infections appears to reduce antibiotic use without affecting overall mortality or length of stay in the hospital.

show abstract

Section: Discussionsupporting

confidence: 75%

Meta-Analysis and Systematic Review of Procalcitonin-Guided Therapy in Respiratory Tract Infections

Luo

Blackwell

et al. 2011

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…38 PCTguided algorithms for the management of critically ill septic patients were shown in a recent meta-analysis of randomized controlled trials to be associated with decreased antibiotic exposure and adverse events. 39 Hence, PCT may be useful for guiding and enforcing antimicrobial stewardship programs in cancer patients, leading to shorter durations of antimicrobial therapy and decreasing the emergence of resistance, as well as lowering treatment costs. This was demonstrated in our study through PCT kinetics, which revealed a significant decrease in association with response to successful antimicrobial therapy in patients with bacterial infections (P < .0001).…”

Section: Original Article 5826mentioning

confidence: 99%

Can procalcitonin distinguish infectious fever from tumor‐related fever in non‐neutropenic cancer patients?

Shomali

Hachem

Chaftari

et al. 2012

Cancer

View full text Add to dashboard Cite

BACKGROUND: Procalcitonin (PCT) has been proposed as a marker of infection and was studied in neutropenic patients. This study investigated its role in non‐neutropenic febrile cancer patients (NNCPs). METHODS: Between July 2009 and July 2010, a total of 248 NNCPs with fever were studied. PCT was measured in plasma within 24 hours of fever onset and 4 to 7 days thereafter, using a Kryptor system with a lower limit of quantitation of 0.075 ng/mL. Patients' clinical, microbiological, and radiological data were reviewed to make the diagnosis and were correlated with PCT levels. RESULTS: This study included 30 patients with bloodstream infection (BSI), 60 with localized bacterial infection, 141 with no documented infection, and 8 with tumor‐related fever. Most patients (98%) were inpatients or admitted to the hospital during the study. Patients with BSI had significantly higher PCT levels than did those with documented localized infections (P = .048) and no documented infection (P = .011). PCT levels were significantly higher in septic patients than in those without sepsis (P = .012). Patients with stage IV disease or metastasis had significantly higher baseline PCT levels than did those with early stages of cancer (P < .05). PCT levels dropped significantly in patients with bacterial infections in response to antibiotics (P < .0001). CONCLUSIONS: Baseline PCT levels are predictive of BSI and sepsis in NNCPs. They may be predictors of metastasis and advanced cancer. Subsequent decrease in PCT levels in response to antibiotics is suggestive of bacterial infection. Larger trials are needed to confirm the results of this pilot study. Cancer 2012. © 2012 American Cancer Society.

show abstract

“…On the other hand, many previous studies demonstrated that PCT could be used to guide antibiotic therapy in patients with infection. [22][23][24] In patients with a new onset of infection after a procedure, various laboratory parameters such as CRP and ESR level may be misleading as they are increased in all patients in the postoperative period and are not specific for underlying PCT as a predictor for infection after SCI surgery H Nie et al infection. 11 A trauma itself and the inflammatory reaction caused by the trauma surgery may stimulate the production of cytokine, leading to a nonspecific increase of these commonly used markers of inflammation.…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury

Nie

Jiang

et al. 2011

Spinal Cord

View full text Add to dashboard Cite

Study design: Prospective, nonrandomized, observational cohort study. Objectives: To analyze procalcitonin (PCT) level in acute traumatic spinal cord injury patients with and without postoperative infectious complications, and to determine whether PCT is a prognostic parameter of infectious complications in the early postoperative period compared with other inflammatory markers. Setting: Spine center of Chongqing, China; Trauma center of Chinese People's Liberation Army, China. Methods: A total of 339 consecutive patients with acute spinal cord injury undergone surgery were evaluated. All patients underwent measurement of leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum PCT preoperatively and 24-48 h postoperatively. Results: In all, 26 (7.7%) of 339 participants experienced postoperative infectious complication. Patients with infection exhibited significantly higher PCT and CRP levels compared with noninfection (both Po0.01). Multivariate logistic regression analysis showed that PCT and CRP levels were independent predicators for postoperative infection. The area under the receiver operating characteristics curve of PCT and CRP were 0.82 (95% confidence intervals (CI) 0.74-0.91) and 0.68 (95%CI, 0.57-0.78), respectively. A PCT cutoff of 0.1 ng ml À1 had a reasonable sensitivity of 92% to exclude an infection and antibiotics can be initially withheld. However, in patients with PCT level above 0.5 ng ml À1 , a rapid initiation of antibiotics may be warranted. Conclusions: Serum PCT is a more reliable biologic marker for the early prediction of postoperative infectious complications in patients with acute traumatic spinal cord injury compared with CRP. PCT can early identify postoperative infections for establishing effective antibiotic therapy.

show abstract

Procalcitonin-guided algorithms of antibiotic therapy in the intensive care unit: A systematic review and meta-analysis of randomized controlled trials

Abstract: The implementation of a procalcitonin-based algorithm may reduce antibiotic exposure in critically ill, septic patients without compromising clinical outcomes, but further research is necessary before the wide adoption of this strategy.

Cited by 228 publications

References 46 publications

Meta-Analysis and Systematic Review of Procalcitonin-Guided Therapy in Respiratory Tract Infections

Meta-Analysis and Systematic Review of Procalcitonin-Guided Therapy in Respiratory Tract Infections

Can procalcitonin distinguish infectious fever from tumor‐related fever in non‐neutropenic cancer patients?

Procalcitonin as an early predictor of postoperative infectious complications in patients with acute traumatic spinal cord injury

Contact Info

Product

Resources

About