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Procalcitonin-Guided Antibiotic Therapy

Slide: 16 of 20

Conclusions (1 of 2)

The strength of evidence was judged to be high that procalcitonin guidance reduces antibiotic usage. The absolute difference in duration of antibiotic use, the measure that was reported by all five studies, ranged from -1.7 to -5.0 days, with relative reductions that ranged from 21 to 38 percent. The strength of evidence was judged low that procalcitonin-guided antibiotic therapy in the intensive care unit (ICU) does not increase mortality. Evidence on mortality was downgraded to low based on uncertainty about the appropriate noninferiority margin for this outcome.

There is moderate-strength evidence that procalcitonin-guided intensification of antibiotic therapy that broadens the spectrum of bacterial coverage does not improve outcomes in critically ill patients and, in fact, may have adverse consequences. A large (n = 1,200), good-quality trial found greater duration and increased total exposure to antibiotics with procalcitonin guidance. There was also increased morbidity, including significant increases in ICU length of stay, days on mechanical ventilation, and days with abnormal renal function.