Procalcitonin-Guided Antibiotic Therapy
Effects of Using Procalcitonin To Guide Antibiotic Therapy in Critically Ill Adult Patients in the ICU (1 of 2)
In the studies included in this review that used procalcitonin-based algorithms, physicians could consider other clinical information and over-ride algorithms based on their clinical judgment.
There was high-strength evidence that procalcitonin guidance reduced antibiotic usage. Five studies reported on antibiotic usage; of these, three were good-quality studies and two were fair-quality studies. The duration of antibiotic therapy was reduced in the procalcitonin-guided arm of all five studies. The absolute difference ranged from -1.7 to -5.0 days, with a percent reduction of 21 to 38 percent. Three studies that reported sufficient information for pooling and yielded a statistically significant pooled mean difference of 2.05 days (95-percent confidence interval [95% CI]: -2.59, -1.52) favoring procalcitonin guidance.
Using procalcitonin guidance did not increase morbidity. The strength of evidence for this finding was rated moderate. Five studies reported on morbidity; of these, four assessed morbidity in terms of intensive care unit (ICU) length of stay and one reported ICU-free days alive. Three studies could be included in the meta-analysis. The pooled mean difference was 0.33 days, but the 95% CI was between -1.88 days and 2.53 days, suggesting that neither procalcitonin nor the control are favored.
Using procalcitonin guidance did not increase mortality (in-hospital mortality, 28-day mortality, or overall mortality). The strength of evidence for this finding was rated low. Five studies reported on mortality; of these, three reported 28-day mortality and in-hospital mortality and two reported overall mortality. A meta-analysis was performed to pool mortality data from all five studies. The results showed a pooled point estimate of a 0.4-percentage point reduction in mortality (95% CI: -6 percent, 5 percent) favoring the procalcitonin-guided therapy group. The strength of evidence for this finding was rated low because of disagreement on the appropriate noninferiority margin.
Keywords: key question | clinical question | finding | outcome | bacterial infection | procalcitonin | antibiotic therapy | intensive care unit | ICU | strength of evidence
- Soni NJ, Samson DJ, Galaydick JL, et al. Procalcitonin-Guided Antibiotic Therapy. Comparative Effectiveness Review No. 78 (Prepared by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. HHSA 290-2007-10058-I). Rockville, MD: Agency for Healthcare Research and Quality; August 2012. AHRQ Publication No. 12-EHC124-EF. Available at www.effectivehealthcare.ahrq.gov/procalcitonin.cfm.
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