Systematic Review and Meta-Analysis of Procalcitonin-Guidance Versus Usual Care for Antimicrobial Management in Critically Ill Patients: Focus on Subgroups Based on Antibiotic Initiation, Cessation, or Mixed Strategies*

Abstract

When evaluating all studies of procalcitonin-guided antibiotics management in critically ill patients, no difference in short-term mortality was observed. However, when only examining procalcitonin-guided cessation of antibiotics, lower mortality was detected. Future studies should focus specifically on procalcitonin for the cessation of antibiotics in critically ill patients.

Recognition and management of respiratory co-infection and secondary bacterial pneumonia in patients with COVID-19

“…Checking the procalcitonin level at presentation will help in the de-escalation of antibiotics based on the trend of procalcitonin levels in 24 to 48 hours. 32 If a microbiological source is not identifi ed within 48 hours of testing and the procalcitonin level is < 0.5 μg/L and/ or decreases by ≥ 80% from peak concentration, it is reasonable to discontinue all antibiotics. 19 The use of interleukin 6 (IL-6) inhibitors such as tocilizumab for COVID-19-related cytokine activation syndrome presents a unique challenge because it suppresses common signs of sepsis.…”

Community-Acquired Pneumonia

“…34 Another metaanalysis showed lower mortality among critically ill patients who were allowed to have procalcitoninguided cessation of antibiotics. 35 Other biomarkers currently under investigation to differentiate viral from bacterial illness include C-reactive protein and cortisol. 15 Although biomarkers may have a future role in risk-stratification of CAP in the ED setting, ED studies are limited at this time (Fig.…”

Prevention of Clostridium difficile Infection in Critically Ill Adults

“…Specifically, one study reported a statistically significant decrease in CDI rate over the 7 years following multidisciplinary ASP implementation, whereas another study found a relative decrease of 64% in CDI rate after incorporating procalcitonin into an established ASP . Further, the use of procalcitonin to guide deescalation may reduce antimicrobial exposure in the ICU and related adverse events including CDI . Components of ASPs can vary widely between institutions, but the SHEA/IDSA CDI guideline emphasizes the importance of shortest effective duration and restriction of antimicrobials that carry the highest CDI risk (e.g., fluoroquinolones, clindamycin, and cephalosporins).…”

“…33,34 Further, the use of procalcitonin to guide deescalation may reduce antimicrobial exposure in the ICU and related adverse events including CDI. 32,35 Components of ASPs can vary widely between institutions, but the SHEA/ IDSA CDI guideline emphasizes the importance of shortest effective duration and restriction of antimicrobials that carry the highest CDI risk (e.g., fluoroquinolones, clindamycin, and cephalosporins). This recommendation is supported by the finding that CDI risk increases 3-fold when antimicrobial therapy exceeds 8 days.…”