Procalcitonin can help guide antibiotic management, including when to discontinue therapy, in ICU patients, a new meta-analysis found.
Researchers searched MEDLINE, EMBASE, the Cochrane Controlled Trials register, and others for comparative studies and systematic reviews on using procalcitonin-guided antibiotic therapy in patients with infections. Specifically, they sought data from randomized, controlled trials that compared using procalcitonin versus clinical criteria to guide initiation, intensification or discontinuation of antibiotic therapy. Outcomes were antibiotic usage, morbidity and mortality. The results were published online August 17 by the Journal of Hospital Medicine.
Data from the 18 qualified studies were pooled into five clinically similar groups. In adult ICU patients, using procalcitonin to guide antibiotic discontinuation lowered the duration of antibiotic use by 2.05 days (95% CI, −2.59 to −1.52) without increasing morbidity or mortality. However, using procalcitonin as an indicator of need for antibiotic intensification led to greater antibiotic usage and morbidity, including longer length of stay and more days on mechanical ventilation. In adults with respiratory tract infections, guidance with procalcitonin significantly reduced antibiotic duration by 2.35 days (95% CI, −4.38 to −0.33) and antibiotic prescription rate by 22% (95% CI, −41% to −4%); it also decreased total antibiotic exposure and didn't affect morbidity or mortality.
The authors noted that, despite some differences between this and previous reviews, the conclusion is the same: Procalcitonin-guided decision making reduces use of antibiotics without changing morbidity and mortality, as compared to clinical criteria-guided decision making. However, procalcitonin shouldn't be used to guide intensification of antibiotics in adult ICU patients, they added, and there's not enough evidence to recommend procalcitonin-guided therapy in postoperative patients at risk for infection.
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