by
Lam, Simon W.; Bauer, Seth R.; Fowler, Robert; Duggal, Abhijit
Objective:
Numerous studies have evaluated the use of procalcitonin guidance during
different phases of antibiotics management (initiation, cessation, or a
combination of both) in patients admitted to ICUs. Several meta-analyses have
attempted to generate an overall effect of procalcitonin-guidance on patient
outcomes. However, combining studies from different phases of antibiotics
management may not be appropriate due to the risk of clinical heterogeneity.
The purpose of this systematic review and meta-analysis was to evaluate the
effect of procalcitonin-guided strategies in different phases of antibiotics
use. Data Sources: We searched MEDLINE and EMBASE from inception until November
1, 2017. Study Selection: We included randomized controlled trials that
evaluated procalcitonin guidance compared with usual care for management of
antibiotics in critically ill adult patients. Data Extraction: We extracted study
details, patient characteristics, procalcitonin algorithm, and outcomes. Data
Synthesis: We included 15 studies, from 1,624 abstracts identified based on our
search strategy (three initiation, nine cessation, and three mixed). The pooled
risk ratio for short-term mortality for the initiation, cessation, and mixed
procalcitonin strategies were 1.00 (95% CI, 0.86–1.15,;p = 0.91), 0.87 (95% CI,
0.77–0.98; p = 0.02), and 1.01 (95% CI, 0.80–1.29; p = 0.93), respectively.
Procalcitonin for cessation and mixed strategies was associated with decrease
antibiotics duration (–1.26 d [p < 0.001] and –3.10 d [p =0.04],
respectively). No differences were observed in other outcome measures.
Conclusion: When evaluating all studies of procalcitonin-guided antibiotics management
in critically ill patients, no difference in short-term mortality was observed.
However, when only examining procalcitonin-guided cessation of antibiotics,
lower mortality was detected. Future studies should focus specifically on
procalcitonin for the cessation of antibiotics in critically ill patients.
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