Delivery and adherence of biomarker‐guided antibiotic treatment protocols in the ADAPT ‐Sepsis clinical trial: an in‐trial descriptive process evaluation of daily procalcitonin‐ and C‐reactive protein‐guided protocols
Main finding · Timing of strong stop adviceResult — go to the resultMean difference −1.7 days 95% CI −2.5 to −0.9Authors' conclusion
A C-reactive protein-guided discontinuation protocol achieved higher clinician adherence, probably because its recommendations aligned more closely with established prescribing norms. In contrast, procalcitonin guidance produced earlier and more frequent stop signals, offering greater potential to reduce antibiotic exposure but requiring clinicians to accept earlier discontinuation than usual practice.
Study context
- Population
- Adults across UK critical care units in the ADAPT-Sepsis trialadults across 41 UK critical care units
- Participants
- 2,760 adults
- Comparison
- Delivery and clinician adherence to procalcitonin- and C-reactive protein-guided protocols
- Outcome
- Timing of strong stop advice
Methodological detailspre-planned, within the multicentre ADAPT-Sepsis trial
- Pre-planned
- Within the multicentre ADAPT-Sepsis trial
Main finding
As reported in the abstract
Mean difference
−1.7 days
95% CI −2.5 to −0.9
P < 0.001
Procalcitonin-guided vs C-reactive protein-guided
mean difference −1.7 days (95% CI −2.5 to −0.9); P < 0.001
Further findings
| Outcome | Mean difference (95% CI) | P value | |
|---|---|---|---|
| Proportion of standard care adviceProcalcitonin-guided vs C-reactive protein-guided | −9.1% (−10.9% to −7.3%) | P < 0.001 | |
| Overall advice adherenceProcalcitonin-guided vs C-reactive protein-guided · adherence greater in the C-reactive protein group | −6.8% (−9.0 to −4.5) | P < 0.001 | |
| Adherence to stronger stop adviceProcalcitonin-guided vs C-reactive protein-guided · higher adherence in the C-reactive protein group | −14.3% (−21.8 to −6.8) | P < 0.001 | |
| −30−20−10010Difference (linear scale) |
- Proportion of standard care advice: C-reactive protein guidance generated a higher proportion of standard care advice
Reasons for advice non-adherence
- Fixed-duration microbiology guidance, illness severity, continuing fever and elevation of routine inflammatory markers; did not differ between groups
Original publication
Delivery and adherence of biomarker‐guided antibiotic treatment protocols in the ADAPT ‐Sepsis clinical trial: an in‐trial descriptive process evaluation of daily procalcitonin‐ and C‐reactive protein‐guided protocols. Anaesthesia. Published 20 October 2026. doi:10.
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