Procalcitonin-Guided Antibiotic Therapy
Effects of Using Procalcitonin To Guide Antibiotic Therapy in Critically Ill Adult Patients in the ICU (2 of 2)
There was moderate-strength evidence that procalcitonin-guided intensification of antibiotic therapy in critically ill adult patients in the intensive care unit (ICU) was associated with greater duration of use and increased total exposure to antibiotics. The evidence to support this finding came from one good-quality study. In this study that included 1,200 patients, procalcitonin-guided intensification resulted in a 2-day (50-percent) increase in the duration of antibiotic therapy. It also resulted in greater antibiotic exposure with a 7.9-percent increase in number of days on three or more antibiotics in the ICU (P = 0.002).
Procalcitonin-guided intensification of antibiotic therapy was associated with increased morbidity (including increase in ICU length of stay, days on mechanical ventilation, and days with abnormal renal function). The strength of evidence for this finding was rated moderate. Two studies reported on procalcitonin-guided antibiotic intensification; one was a fair-quality study and the other was a good-quality study. The fair-quality study showed a 3.3-day reduction in ICU stay, which was not statistically significant. The good-quality study showed a significant 1-day increase in ICU length of stay. Furthermore, this larger good-quality study demonstrated a significant increase in organ dysfunction, specifically an extra five days of mechanical ventilation and an additional five days of abnormal renal function, both of which were statistically significant.
Keywords: antibiotic therapy | bacterial infection | clinical question | finding | ICU | intensive care unit | outcome | procalcitonin | strength of evidence | key question
- 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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