Effects and Safety of Procalcitonin-Guided Algorithms of Antibiotic Therapy in Critically Ill Patients: A Meta-Analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

DongLiang ¹ , LiLang ² , ZhangXiuhong ³ , YanJie ¹ ,  YanZheng ¹

1. Department of Critical Care Medicine, Wuxi People's Hospital, Wuxi, Jiangsu, 214023, China;
2. ;
3. ;

Corresponding author：

YanZheng, Email: yz101999@sina.com

Keywords：

Procalcitonin; Critically ill; Duration of antibiotic therapy; Adverse reaction; Mortality; Meta-analysis

DOI：

10.7507/1671-6205.2016103

Video：

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Objective To evaluate the effects and safety of procalcitonin(PCT)-guided algorithms of antibiotic therapy in critically ill patients in intensive care unit (ICU). Methods Literatures in English and Chinese concerning randomized controlled trials(RCTs) on PCT-guided algorithms of antibiotic therapy in critically ill patients was retrieved by electronic and manual search. All related data were extracted. Meta-analysis was conducted using the statistical software RevMan 5.3 on the basis of strict quality evaluation. Results Eight RCTs involving 2708 ICU patients were included, with 1360 patients in the PCT-guided group and 1348 patients in the control group. Compared with the control group, PCT-guided algorithms were associated with a significant reduction in the duration of antibiotic therapy (MD -2.44 days, 95%CI -3.25 to -1.62, P < 0.00001), and the occurrence of adverse reaction of antibiotics was also lower (RR=0.74, 95%CI 0.56 to 0.97, P=0.03), however the mortality exhibited no difference between the PCT-guided group and the control group (RR=1.00, 95%CI 0.89 to 1.13, P=0.99). Conclusion PCT-guided algorithms can shorten the duration of antibiotic therapy and reduce the occurrence of adverse reaction in critically ill patients without significant effect on mortality.

Citation： Dong Liang, Li Lang, Zhang Xiuhong, Yan Jie, Yan Zheng. Effects and Safety of Procalcitonin-Guided Algorithms of Antibiotic Therapy in Critically Ill Patients: A Meta-Analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(5): 437-441. doi: 10.7507/1671-6205.2016103 Copy

1.	Gandhi TN, DePestel DD, Collins CD, et al. Managing antimicrobial resistance in intensive care units. Crit Care Med, 2010, 38:S315-S323.
2.	Álvarez-Lerma F, Grau S. Management of antimicrobial use in the intensive care unit. Drugs, 2012, 72:447-470.
3.	Chastre J, Wolff M, Fagon JY, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults:a randomized trial. JAMA, 2003, 290:2588-2598.
4.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary? Control Clin Trials, 1996, 17:1-12.
5.	Svoboda P, Kantorová I, Scheer P, et al. Can procalcitonin help us in timing of re-intervention in septic patients after multiple trauma or major surgery? Hepatogastroenterology, 2007, 54:359-363.
6.	Nobre V, Harbarth S, Graf JD, et al. Use of procalcitonin to shorten antibiotic treatment duration in septic patients:a randomized trial. Am J Respir Crit Care, 2008, 177:498-505.
7.	Hochreiter M, Köhler T, Schweiger AM, et al. Procalcitonin to guide duration of antibiotic therapy in intensive care patients:a randomized prospective controlled trial. Crit Care, 2009, 13:R83.
8.	Schroeder S, Hochreiter M, Koehler T, et al. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis:results of a prospective randomized study. Langenbecks Arch Surg, 2009, 394:221-226.
9.	Stolz D, Smyrnios N, Eggimann P, et al. Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia:a randomised study. Eur Respir J, 2009, 34:1364-1375.
10.	Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial):a multicentre randomised controlled trial. Lancet, 2010, 375:463-474.
11.	Jensen JU, Hein L, Lundgren B, et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit:a randomized trial. Crit Care Med, 2011, 39:2048-2058.
12.	Layios N, Lambermont B, Canivet JL, et al. Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients. Crit Care Med, 2012, 40:2304-2309.
13.	Kumar Av, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med, 2006, 34:1589-1596.
14.	Guillemot D, Courvalin P. Better control of antibiotic resistance. Clin Infect Dis, 2001, 33:542-547.
15.	Müller B, Harbarth S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis, 2007, 7:10.
16.	Maseda E, Suarez-de-la-Rica A, Anillo V, et al. Procalcitonin-guided therapy may reduce length of antibiotic treatment in intensive care unit patients with secondary peritonitis:a multicenter retrospective study. J Crit Care, 2015, 30:537-542.
17.	Barrett J, Edgeworth J, Wyncoll D, et al. Shortening the course of antibiotic treatment in the intensive care unit. Expert Rev Anti Infect Ther, 2015, 13:463-471.
18.	Bishop BM, Bon JJ, Trienski TL, et al. Effect of introducing procalcitonin on antimicrobial therapy duration in patients with sepsis and/or pneumonia in the intensive care unit. Ann Pharmacother, 2014, 48:577-583.
19.	Hohn A, Heising B, Hertel S, et al. Antibiotic consumption after implementation of a procalcitonin-guided antimicrobial stewardship programme in surgical patients admitted to an intensive care unit:a retrospective before-and-after analysis. Infection, 2015, 43:405-412.
20.	Matsumura Y, Nakada TA, Abe R, et al. Serum procalcitonin level and SOFA score at discharge from the intensive care unit predict post-intensive care unit mortality:a prospective study. PLoS One, 2014, 9:e114007.
21.	Bréchot N, Hékimian G, Chastre J, et al. Procalcitonin to guide antibiotic therapy in the ICU. Int J Antimicrob Agents, 2015, 46(Suppl 1):S19-S24.

1. Gandhi TN, DePestel DD, Collins CD, et al. Managing antimicrobial resistance in intensive care units. Crit Care Med, 2010, 38:S315-S323.
2. Álvarez-Lerma F, Grau S. Management of antimicrobial use in the intensive care unit. Drugs, 2012, 72:447-470.
3. Chastre J, Wolff M, Fagon JY, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults:a randomized trial. JAMA, 2003, 290:2588-2598.
4. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials:is blinding necessary? Control Clin Trials, 1996, 17:1-12.
5. Svoboda P, Kantorová I, Scheer P, et al. Can procalcitonin help us in timing of re-intervention in septic patients after multiple trauma or major surgery? Hepatogastroenterology, 2007, 54:359-363.
6. Nobre V, Harbarth S, Graf JD, et al. Use of procalcitonin to shorten antibiotic treatment duration in septic patients:a randomized trial. Am J Respir Crit Care, 2008, 177:498-505.
7. Hochreiter M, Köhler T, Schweiger AM, et al. Procalcitonin to guide duration of antibiotic therapy in intensive care patients:a randomized prospective controlled trial. Crit Care, 2009, 13:R83.
8. Schroeder S, Hochreiter M, Koehler T, et al. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis:results of a prospective randomized study. Langenbecks Arch Surg, 2009, 394:221-226.
9. Stolz D, Smyrnios N, Eggimann P, et al. Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia:a randomised study. Eur Respir J, 2009, 34:1364-1375.
10. Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial):a multicentre randomised controlled trial. Lancet, 2010, 375:463-474.
11. Jensen JU, Hein L, Lundgren B, et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit:a randomized trial. Crit Care Med, 2011, 39:2048-2058.
12. Layios N, Lambermont B, Canivet JL, et al. Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients. Crit Care Med, 2012, 40:2304-2309.
13. Kumar Av, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med, 2006, 34:1589-1596.
14. Guillemot D, Courvalin P. Better control of antibiotic resistance. Clin Infect Dis, 2001, 33:542-547.
15. Müller B, Harbarth S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis, 2007, 7:10.
16. Maseda E, Suarez-de-la-Rica A, Anillo V, et al. Procalcitonin-guided therapy may reduce length of antibiotic treatment in intensive care unit patients with secondary peritonitis:a multicenter retrospective study. J Crit Care, 2015, 30:537-542.
17. Barrett J, Edgeworth J, Wyncoll D, et al. Shortening the course of antibiotic treatment in the intensive care unit. Expert Rev Anti Infect Ther, 2015, 13:463-471.
18. Bishop BM, Bon JJ, Trienski TL, et al. Effect of introducing procalcitonin on antimicrobial therapy duration in patients with sepsis and/or pneumonia in the intensive care unit. Ann Pharmacother, 2014, 48:577-583.
19. Hohn A, Heising B, Hertel S, et al. Antibiotic consumption after implementation of a procalcitonin-guided antimicrobial stewardship programme in surgical patients admitted to an intensive care unit:a retrospective before-and-after analysis. Infection, 2015, 43:405-412.
20. Matsumura Y, Nakada TA, Abe R, et al. Serum procalcitonin level and SOFA score at discharge from the intensive care unit predict post-intensive care unit mortality:a prospective study. PLoS One, 2014, 9:e114007.
21. Bréchot N, Hékimian G, Chastre J, et al. Procalcitonin to guide antibiotic therapy in the ICU. Int J Antimicrob Agents, 2015, 46(Suppl 1):S19-S24.

Chinese Journal of Respiratory and Critical Care Medicine

Effects and Safety of Procalcitonin-Guided Algorithms of Antibiotic Therapy in Critically Ill Patients: A Meta-Analysis

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