Procalcitonin-guided Antibiotic Treatment in Patients With Positive Blood Cultures: A Patient-level Meta-analysis of Randomized Trials
Whether procalcitonin (PCT)-guided antibiotic management in patients with positive blood cultures is safe remains understudied. We performed a patient-level meta-analysis to investigate effects of PCT-guided antibiotic management in patients with bacteremia. We extracted and analyzed individual data...
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| Published in: | Clinical infectious diseases Vol. 69; no. 3; p. 388 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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18.07.2019
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| ISSN: | 1537-6591, 1537-6591 |
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| Abstract | Whether procalcitonin (PCT)-guided antibiotic management in patients with positive blood cultures is safe remains understudied. We performed a patient-level meta-analysis to investigate effects of PCT-guided antibiotic management in patients with bacteremia.
We extracted and analyzed individual data of 523 patients with positive blood cultures included in 13 trials, in which patients were randomly assigned to receive antibiotics based on PCT levels (PCT group) or a control group. The main efficacy endpoint was duration of antibiotic treatment. The main safety endpoint was mortality within 30 days.
Mean duration of antibiotic therapy was significantly shorter for 253 patients who received PCT-guided treatment than for 270 control patients (-2.86 days [95% confidence interval [CI], -4.88 to -.84]; P = .006). Mortality was similar in both arms (16.6% vs 20.0%; P = .263). In subgroup analyses by type of pathogen, we noted a trend of shorter mean antibiotic durations in the PCT arm for patients infected with gram-positive organisms or Escherichia coli and significantly shorter treatment for subjects with pneumococcal bacteremia. In analysis by site of infection, antibiotic exposure was shortened in PCT subjects with Streptococcus pneumoniae respiratory infection and those with E. coli urogenital infections.
This meta-analysis of patients with bacteremia receiving PCT-guided antibiotic management demonstrates lower antibiotic exposure without an apparent increase in mortality. Few differences were demonstrated in subgroup analysis stratified by type or site of infection but notable for decreased exposure in patients with pneumococcal pneumonia and E. coli urogenital infections. |
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| AbstractList | Whether procalcitonin (PCT)-guided antibiotic management in patients with positive blood cultures is safe remains understudied. We performed a patient-level meta-analysis to investigate effects of PCT-guided antibiotic management in patients with bacteremia.BACKGROUNDWhether procalcitonin (PCT)-guided antibiotic management in patients with positive blood cultures is safe remains understudied. We performed a patient-level meta-analysis to investigate effects of PCT-guided antibiotic management in patients with bacteremia.We extracted and analyzed individual data of 523 patients with positive blood cultures included in 13 trials, in which patients were randomly assigned to receive antibiotics based on PCT levels (PCT group) or a control group. The main efficacy endpoint was duration of antibiotic treatment. The main safety endpoint was mortality within 30 days.METHODSWe extracted and analyzed individual data of 523 patients with positive blood cultures included in 13 trials, in which patients were randomly assigned to receive antibiotics based on PCT levels (PCT group) or a control group. The main efficacy endpoint was duration of antibiotic treatment. The main safety endpoint was mortality within 30 days.Mean duration of antibiotic therapy was significantly shorter for 253 patients who received PCT-guided treatment than for 270 control patients (-2.86 days [95% confidence interval [CI], -4.88 to -.84]; P = .006). Mortality was similar in both arms (16.6% vs 20.0%; P = .263). In subgroup analyses by type of pathogen, we noted a trend of shorter mean antibiotic durations in the PCT arm for patients infected with gram-positive organisms or Escherichia coli and significantly shorter treatment for subjects with pneumococcal bacteremia. In analysis by site of infection, antibiotic exposure was shortened in PCT subjects with Streptococcus pneumoniae respiratory infection and those with E. coli urogenital infections.RESULTSMean duration of antibiotic therapy was significantly shorter for 253 patients who received PCT-guided treatment than for 270 control patients (-2.86 days [95% confidence interval [CI], -4.88 to -.84]; P = .006). Mortality was similar in both arms (16.6% vs 20.0%; P = .263). In subgroup analyses by type of pathogen, we noted a trend of shorter mean antibiotic durations in the PCT arm for patients infected with gram-positive organisms or Escherichia coli and significantly shorter treatment for subjects with pneumococcal bacteremia. In analysis by site of infection, antibiotic exposure was shortened in PCT subjects with Streptococcus pneumoniae respiratory infection and those with E. coli urogenital infections.This meta-analysis of patients with bacteremia receiving PCT-guided antibiotic management demonstrates lower antibiotic exposure without an apparent increase in mortality. Few differences were demonstrated in subgroup analysis stratified by type or site of infection but notable for decreased exposure in patients with pneumococcal pneumonia and E. coli urogenital infections.CONCLUSIONSThis meta-analysis of patients with bacteremia receiving PCT-guided antibiotic management demonstrates lower antibiotic exposure without an apparent increase in mortality. Few differences were demonstrated in subgroup analysis stratified by type or site of infection but notable for decreased exposure in patients with pneumococcal pneumonia and E. coli urogenital infections. Whether procalcitonin (PCT)-guided antibiotic management in patients with positive blood cultures is safe remains understudied. We performed a patient-level meta-analysis to investigate effects of PCT-guided antibiotic management in patients with bacteremia. We extracted and analyzed individual data of 523 patients with positive blood cultures included in 13 trials, in which patients were randomly assigned to receive antibiotics based on PCT levels (PCT group) or a control group. The main efficacy endpoint was duration of antibiotic treatment. The main safety endpoint was mortality within 30 days. Mean duration of antibiotic therapy was significantly shorter for 253 patients who received PCT-guided treatment than for 270 control patients (-2.86 days [95% confidence interval [CI], -4.88 to -.84]; P = .006). Mortality was similar in both arms (16.6% vs 20.0%; P = .263). In subgroup analyses by type of pathogen, we noted a trend of shorter mean antibiotic durations in the PCT arm for patients infected with gram-positive organisms or Escherichia coli and significantly shorter treatment for subjects with pneumococcal bacteremia. In analysis by site of infection, antibiotic exposure was shortened in PCT subjects with Streptococcus pneumoniae respiratory infection and those with E. coli urogenital infections. This meta-analysis of patients with bacteremia receiving PCT-guided antibiotic management demonstrates lower antibiotic exposure without an apparent increase in mortality. Few differences were demonstrated in subgroup analysis stratified by type or site of infection but notable for decreased exposure in patients with pneumococcal pneumonia and E. coli urogenital infections. |
| Author | Neeser, Olivia L Tubach, Florence Shehabi, Yahya Haubitz, Sebastian Luyt, Charles E Corti, Caspar Schuetz, Philipp Damas, Pierre Tamm, Michael Branche, Angela Christ-Crain, Mirjam Oliveira, Carolina F Wirz, Yannick Stolz, Daiana Deliberato, Rodrigo O Meier, Marc A Wolff, Michel Mueller, Beat Chastre, Jean Kristoffersen, Kristina B Bouadma, Lila Nobre, Vandack Jensen, Jens-Ulrik S |
| Author_xml | – sequence: 1 givenname: Marc A surname: Meier fullname: Meier, Marc A organization: Medical University Department, Kantonsspital Aarau, Switzerland – sequence: 2 givenname: Angela surname: Branche fullname: Branche, Angela organization: Department of Medicine, University of Rochester, Rochester General Hospital, New York – sequence: 3 givenname: Olivia L surname: Neeser fullname: Neeser, Olivia L organization: Medical University Department, Kantonsspital Aarau, Switzerland – sequence: 4 givenname: Yannick surname: Wirz fullname: Wirz, Yannick organization: Medical University Department, Kantonsspital Aarau, Switzerland – sequence: 5 givenname: Sebastian surname: Haubitz fullname: Haubitz, Sebastian organization: Medical University Department, Kantonsspital Aarau, Switzerland – sequence: 6 givenname: Lila surname: Bouadma fullname: Bouadma, Lila organization: Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique-Hôpitaux de Paris (AP-HP), France – sequence: 7 givenname: Michel surname: Wolff fullname: Wolff, Michel organization: Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique-Hôpitaux de Paris (AP-HP), France – sequence: 8 givenname: Charles E surname: Luyt fullname: Luyt, Charles E organization: Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, France – sequence: 9 givenname: Jean surname: Chastre fullname: Chastre, Jean organization: Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, France – sequence: 10 givenname: Florence surname: Tubach fullname: Tubach, Florence organization: Département d'Epidémiologie Biostatistique et Recherche Clinique, AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, France – sequence: 11 givenname: Mirjam surname: Christ-Crain fullname: Christ-Crain, Mirjam organization: Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Switzerland – sequence: 12 givenname: Caspar surname: Corti fullname: Corti, Caspar organization: Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Denmark – sequence: 13 givenname: Jens-Ulrik S surname: Jensen fullname: Jensen, Jens-Ulrik S organization: Department of Internal Medicine, Respiratory Medicine Section, Copenhagen University Hospital Herlev-Gentofte Hospital, Denmark – sequence: 14 givenname: Rodrigo O surname: Deliberato fullname: Deliberato, Rodrigo O organization: Critical Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil – sequence: 15 givenname: Kristina B surname: Kristoffersen fullname: Kristoffersen, Kristina B organization: Department of Infectious Diseases, Aarhus University Hospital, Denmark – sequence: 16 givenname: Pierre surname: Damas fullname: Damas, Pierre organization: Department of General Intensive Care, University Hospital of Liege, Domaine universitaire de Liège, Belgium – sequence: 17 givenname: Vandack surname: Nobre fullname: Nobre, Vandack organization: Department of Intensive Care, Hospital das Clinicas, Belo Horizonte, Brazil – sequence: 18 givenname: Carolina F surname: Oliveira fullname: Oliveira, Carolina F organization: Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil – sequence: 19 givenname: Yahya surname: Shehabi fullname: Shehabi, Yahya organization: School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia – sequence: 20 givenname: Daiana surname: Stolz fullname: Stolz, Daiana organization: Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Switzerland – sequence: 21 givenname: Michael surname: Tamm fullname: Tamm, Michael organization: Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Switzerland – sequence: 22 givenname: Beat surname: Mueller fullname: Mueller, Beat organization: Faculty of Medicine, University of Basel, Switzerland – sequence: 23 givenname: Philipp surname: Schuetz fullname: Schuetz, Philipp organization: Faculty of Medicine, University of Basel, Switzerland |
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| Keywords | procalcitonin antibiotic stewardship positive blood cultures bacteremia |
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| Title | Procalcitonin-guided Antibiotic Treatment in Patients With Positive Blood Cultures: A Patient-level Meta-analysis of Randomized Trials |
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