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Procalcitonin-Guided Antibiotic Therapy

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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.