The following is a summary of “Procalcitonin-guided antibiotic therapy may shorten length of treatment and may improve survival—a systematic review and meta-analysis,” published in the October 2023 issue of Critical Care by Papp et al.
Appropriate antibiotic (AB) therapy in the intensive care unit (ICU) is challenging; procalcitonin (PCT)-guided AB stewardship may help. Researchers started a retrospective study to investigate whether PCT-guided antibiotic therapy could outperform the standard of care (SOC) in critically ill patients.
They searched databases CENTRAL, Embase, and Medline. Randomized controlled trials (RCTs) that compared PCT-guided AB therapy (PCT group) with SOC, reporting on the duration of AB therapy, mortality, recurrent and secondary infection, ICU length of stay (LOS), hospital LOS, or healthcare costs, were included. Subgroup analyses were conducted in studies applying the Sepsis-3 definition due to recent changes in sepsis definitions. The statistical analysis employed a random-effects model to combine effect sizes.
The results showed 26 RCTs (n = 9,048 patients) in the quantitative analysis. Compared with SOC, the PCT group exhibited a significantly shorter length of AB therapy (MD − 1.79 days, 95% CI: -2.65, − 0.92) with lower 28-day mortality (OR 0.84, 95% CI: 0.74, 0.95). In Sepsis-3 patients, the mortality benefit was more pronounced (OR 0.46, 95% CI: 0.27, 0.79). The odds of recurrent infection were significantly higher in the PCT group (OR 1.36, 95% CI: 1.10, 1.68), but there was no significant difference in the odds of secondary infection (OR 0.81, 95% CI: 0.54, 1.21), ICU length of stay (MD − 0.67 days, 95% CI: − 1.76, 0.41), and hospital length of stay (MD − 1.23 days, 95% CI: − 3.13, 0.67).
They concluded that PCT-guided AB therapy may reduce antibiotic use and mortality, but more research is needed to confirm its benefits and risks in critically ill patients.