Procalcitonin-guided Antibiotic Treatment in Patients With Positive Blood Cultures: A Patient-level Meta-analysis of Randomized Trials

Meier, Marc; Branche, Angela; Neeser, Olivia; Wirz, Yannick; Haubitz, Sebastian; Bouadma, Lila; Wolff, Michel; Luyt, Charles Edouard; Chastre, Jean; Tubach, Florence; Christ‐Crain, Mirjam; Corti, Caspar; Jensen, Jens Ulrik Stæhr; Deliberato, Rodrigo Octávio; Kristoffersen, Kristina B; Damas, Pierre; Nobre, Vandack; Oliveira, Carolina; Shehabi, Yahya; Stolz, Daiana; Tamm, Michael; Müeller, Beat; Schuetz, Philipp

doi:10.1093/cid/ciy917

Cited by 68 publications

(45 citation statements)

References 25 publications

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“…A further meta-analysis also revealed, that survival benefit was associated with a PCT algorithm for cessation of antibiotics only, whereas for ICU patients a PCT algorithm for antibiotic initiation or a mixed approach did not reduce mortality [27]. Finally, a meta-analysis focusing on bacteremic patients with positive cultures also found a significant effect of PCT use on antibiotic usage with no evidence for adverse clinical outcomes despite shorter antibiotic durations [28].…”

Section: Trials and Algorithms For Pct-guided Abs In Sepsismentioning

confidence: 92%

Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

Шуц¹,

Beishuizen²,

Бройлс³

et al. 2019

Lab. sluzh.

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Background: Procalcitonin (PCT)-guided antibiotic stewardship (ABS) has been shown to reduce antibiotics (ABxs), with lower side-effects and an improvement in clinical outcomes. The aim of this experts workshop was to derive a PCT algorithm ABS for easier implementation into clinical routine across different clinical settings. Methods: Clinical evidence and practical experience with PCT-guided ABS was analyzed and discussed, with a focus on optimal PCT use in the clinical context and increased adherence to PCT protocols. Using a Delphi process, the experts group reached consensus on different PCT algorithms based on clinical severity of the patient and probability of bacterial infection. Results: The group agreed that there is strong evidence that PCT-guided ABS supports individual decisions on initiation and duration of ABx treatment in patients with acute respiratory infections and sepsis from any source, thereby reducing overall ABx exposure and associated side effects, and improving clinical outcomes. To simplify practical application, the expert group refined the established PCT algorithms by incorporating severity of illness and probability of bacterial infection and reducing the

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Section: Trials and Algorithms For Pct-guided Abs In Sepsismentioning

confidence: 92%

Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

Шуц¹,

Beishuizen²,

Бройлс³

et al. 2019

Lab. sluzh.

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“…Therefore, PCT has been shown to be able to help decision-making for both initiation and cessation of antibiotic treatment in patients with LRTIs 36,[38][39][40] and is widely recognised as an effective biomarker for bacterial infection 36,41,42 . In a meta-analysis of 12 studies, PCT was compared to CRP and the diagnostic accuracy of PCT was shown to be higher than that of CRP among patients hospitalised for suspected bacterial infections 43 .…”

Section: Diagnostic Value Of Procalcitoninmentioning

confidence: 99%

The Case of Procalcitonin for Lower Respiratory Tract Infections

Karakioulaki¹,

Stolz²

2021

BRN

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Lower respiratory tract infections (LRTIs) contribute significantly to the morbidity and mortality among all age groups. Antibiotics can effectively treat LRTIs due to bacterial infection. Unfortunately, they are commonly prescribed even when the cause of the infection is non-bacterial, leading to an increase in antimicrobial resistance, mortality and health costs. This review aims to highlight the importance of procalcitonin (PCT) for the diagnosis of bacterial LRTIs. We conclude that PCT serum levels can help clinicians establish the need for antibiotics and individualise the duration of treatment in LRTIs. In addition, serum PCT provide prognostic information about the severity of the disease. However, PCT serum levels cannot inform decisions on a stand-alone fashion and should not be expected to substitute a thorough history and physical examination. (BRN Rev. 2019;5(4):277-93)

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“…We conducted a secondary analysis using our updated individual patient database [11,14,15,[24][25][26][27]. The study selection and data collection was based on the original protocol published in the Cochrane Library [28] and the report was prepared following the Preferred Reporting Items for Systematic Review and Meta-Analysis individual participant data guidelines [29,30].…”

Section: Patient Population and Trial Selectionmentioning

confidence: 99%

Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: a patient-level meta-analysis from randomized controlled trials

Heilmann

Gregoriano

Wirz

et al. 2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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ObjectivesPatients with impaired kidney function have a significantly slower decrease of procalcitonin (PCT) levels during infection. Our aim was to study PCT-guided antibiotic stewardship and clinical outcomes in patients with impairments of kidney function as assessed by creatinine levels measured upon hospital admission.MethodsWe pooled and analyzed individual data from 15 randomized controlled trials who were randomly assigned to receive antibiotic therapy based on a PCT-algorithms or based on standard of care. We stratified patients on the initial glomerular filtration rate (GFR, ml/min/1.73 m2) in three groups (GFR >90 [chronic kidney disease; CKD 1], GFR 15–89 [CKD 2–4] and GFR<15 [CKD 5]). The main efficacy and safety endpoints were duration of antibiotic treatment and 30-day mortality.ResultsMean duration of antibiotic treatment was significantly shorter in PCT-guided (n=2,492) compared to control patients (n=2,510) (9.5–7.6 days; adjusted difference in days −2.01 [95% CI, −2.45 to −1.58]). CKD 5 patients had overall longer treatment durations, but a 2.5-day reduction in treatment duration was still found in patients receiving in PCT-guided care (11.3 vs. 8.6 days [95% CI −3.59 to −1.40]). There were 397 deaths in 2,492 PCT-group patients (15.9%) compared to 460 deaths in 2,510 control patients (18.3%) (adjusted odds ratio, 0.88 [95% CI 0.78 to 0.98)]. Effects of PCT-guidance on antibiotic treatment duration and mortality were similar in subgroups stratified by infection type and clinical setting (p interaction >0.05).ConclusionsThis individual patient data meta-analysis confirms that the use of PCT in patients with impaired kidney function, as assessed by admission creatinine levels, is associated with shorter antibiotic courses and lower mortality rates.

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Procalcitonin-guided Antibiotic Treatment in Patients With Positive Blood Cultures: A Patient-level Meta-analysis of Randomized Trials

Cited by 68 publications

References 25 publications

Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use

The Case of Procalcitonin for Lower Respiratory Tract Infections

Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: a patient-level meta-analysis from randomized controlled trials

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