Article (Scientific journals)
Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis
Schuetz, Philipp; Wirz, Yannick; Sager, Ramon et al.
2018In The Lancet Infectious Diseases, 18 (1), p. 95-107
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Abstract :
[en] Background In February, 2017, the US Food and Drug Administration approved the blood infection marker procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety of procalcitonin-guided treatment in patients with acute respiratory infections from different clinical settings. Methods Based on a prespecified Cochrane protocol, we did a systematic literature search on the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, and pooled individual patient data from trials in which patients with respiratory infections were randomly assigned to receive antibiotics based on procalcitonin concentrations (procalcitonin-guided group) or control. The coprimary endpoints were 30-day mortality and setting-specific treatment failure. Secondary endpoints were antibiotic use, length of stay, and antibiotic side-effects. Findings We identified 990 records from the literature search, of which 71 articles were assessed for eligibility after exclusion of 919 records. We collected data on 6708 patients from 26 eligible trials in 12 countries. Mortality at 30 days was significantly lower in procalcitonin-guided patients than in control patients (286 [9%] deaths in 3336 procalcitonin-guided patients vs 336 [10%] in 3372 controls; adjusted odds ratio [OR] 0·83 [95% CI 0·70 to 0·99], p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (pinteractions>0·05), although mortality was very low in primary care and in patients with acute bronchitis. Procalcitonin guidance was also associated with a 2·4-day reduction in antibiotic exposure (5·7 vs 8·1 days [95% CI −2·71 to −2·15], p<0·0001) and a reduction in antibiotic-related side-effects (16% vs 22%, adjusted OR 0·68 [95% CI 0·57 to 0·82], p<0·0001). Interpretation Use of procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance. Funding National Institute for Health Research. © 2018 Elsevier Ltd
Disciplines :
Anesthesia & intensive care
Author, co-author :
Schuetz, Philipp;  Medical University Department, Kantonsspital Aarau, Aarau, Switzerland, Faculty of Medicine, University of Basel, Basel, Switzerland
Wirz, Yannick;  Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
Sager, Ramon;  Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
Christ-Crain, Mirjam;  Faculty of Medicine, University of Basel, Basel, Switzerland, Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
Stolz, D;  Faculty of Medicine, University of Basel, Basel, Switzerland, Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
Tamm, M.;  Faculty of Medicine, University of Basel, Basel, Switzerland, Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
Bouadma, L.;  Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
Luyt, C. E.;  Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, Paris, France
Wolff, M.;  Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique Hôpitaux de Paris (AP-HP), Paris, France
Chastre, Jean;  Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, Paris, France
Tubach, F.;  Département de Biostatistique, Santé publique et Information médicale, AP-HP, Hôpital Pitié-Salpêtrière, Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
Kristoffersen, K. B.;  Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
Burkhardt, O.;  Department of Pulmonary Medicine, Medizinische Hochschule Hannover, Member of the German Center of Lung Research, Hannover, Germany
Welte, T.;  Department of Pulmonary Medicine, Medizinische Hochschule Hannover, Member of the German Center of Lung Research, Hannover, Germany
Schroeder, S.;  Department of Anesthesiology and Intensive Care Medicine, Krankenhaus Dueren, Dueren, Germany
Nobre, V.;  Department of Intensive Care, Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Wei, L.;  Department of Internal and Geriatric Medicine, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, China
Bucher, H. C.;  Faculty of Medicine, University of Basel, Basel, Switzerland, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
Annane, D.;  Critical Care Department, Hôpital Raymond Poincaré, AP-HP, Faculty of Health Science Simone Veil, UVSQ–University Paris Saclay, Garches, France
Reinhart, K.;  Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
Falsey, A. R.;  Department of Medicine, University of Rochester, Rochester, NY, United States
Branche, A.;  Department of Medicine, University of Rochester, Rochester, NY, United States
Damas, Pierre ;  Université de Liège - ULiège > Département des sciences cliniques > Anesthésie et réanimation
Nijsten, M.;  University Medical Centre, University of Groningen, Groningen, Netherlands
de Lange, D. W.;  University Medical Center Utrecht and University of Utrecht, Utrecht, Netherlands
Deliberato, R. O.;  Critical Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Oliveira, C. F.;  Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Maravić-Stojković, V.;  Immunology Laboratory, Dedinje Cardiovascular Institute, Belgrade, Serbia
Verduri, A.;  Section of Respiratory Medicine, Department of Medical and Surgical Sciences, University Polyclinic of Modena, University of Modena and Reggio Emilia, Modena, Italy
Beghé, B.;  Section of Respiratory Medicine, Department of Medical and Surgical Sciences, University Polyclinic of Modena, University of Modena and Reggio Emilia, Modena, Italy
Cao, B.;  Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
Shehabi, Y.;  Critical Care and Peri-operative Medicine, Monash Health, Melbourne, VIC, Australia, School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
Jensen, J.-U. S.;  Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases and Rheumatology, Finsencentret, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Corti, C.;  Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
van Oers, J. A. H.;  Elisabeth Tweesteden Hospital, Tilburg, Netherlands
Beishuizen, A.;  Medisch Spectrum Twente, Enschede, Netherlands
Girbes, A. R. J.;  VUmc University Medical Center, Amsterdam, Netherlands
de Jong, E.;  VUmc University Medical Center, Amsterdam, Netherlands
Briel, M.;  Faculty of Medicine, University of Basel, Basel, Switzerland, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
Mueller, B.;  Medical University Department, Kantonsspital Aarau, Aarau, Switzerland, Faculty of Medicine, University of Basel, Basel, Switzerland
More authors (30 more) Less
Language :
English
Title :
Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis
Publication date :
2018
Journal title :
The Lancet Infectious Diseases
ISSN :
1473-3099
eISSN :
1474-4457
Publisher :
Lancet Publishing Group
Volume :
18
Issue :
1
Pages :
95-107
Peer reviewed :
Peer Reviewed verified by ORBi
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