Procalcitonin-guided antibiotic therapy may shorten length of treatment and may improve survival—a systematic review and meta-analysis
Pooled result · Length of AB therapyResult — go to the resultMD - 1.79 days 95% CI −2.65, - 0.92Authors' conclusion
PCT-guided AB therapy may be associated with reduced AB use, lower 28-day mortality but higher infection recurrence, with similar ICU and hospital length of stay.
Study context
- Population
- Critically ill patients
- Participants
- 9,048 patients · 26 randomized controlled trials (RCTs)
- Comparison
- Procalcitonin (PCT)-guided antibiotic (AB) therapy vs standard of care (SOC)
- Outcome
- Length of AB therapy
Methodological detailsrandom-effects model, Sepsis-3 subgroup analysis
- Random-effects model
- Sepsis-3 subgroup analysis
Pooled result
As reported in the abstract
MD
- 1.79 days
95% CI −2.65, - 0.92
PCT vs SOC
MD - 1.79 days (95% CI −2.65, - 0.92)
Further pooled results
| Outcome | OR (95% CI) | |
|---|---|---|
| 28-day mortality · random-effects model | 0.84 (0.74–0.95) | |
| Recurrent infectionSignificantly higher in the PCT group | 1.36 (1.10–1.68) | |
| Secondary infection | 0.81 (0.54–1.21) | |
| 0.512Odds ratio (log scale) |
| Outcome | MD (days) (95% CI) |
|---|---|
| ICU LOSNo significant difference | - 0.67 (- 1.76, 0.41) |
| Hospital LOSNo significant difference | - 1.23 (- 3.13, 0.67) |
Mortality, Sepsis-3 patients (subgroup)
- Mortality benefit more pronounced in Sepsis-3 patients (OR, 95% CI)
- OR 0.46 95% CI: 0.27, 0.79
- Subgroup analysis of studies applying the Sepsis-3 definition
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Recurrent infectionSignificantly higher in the PCT group | 1.36 (1.10–1.68) | |
| 0.512Odds ratio (log scale) |
Original publication
Procalcitonin-guided antibiotic therapy may shorten length of treatment and may improve survival—a systematic review and meta-analysis. Crit Care. Published 13 October 2023. doi:10.
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