Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials


Eva Heilmann, Kantonsspital Aarau
Claudia Gregoriano, Kantonsspital Aarau
Djillali Annane, Hopital Raymond Poincare
Konrad Reinhart, Universitätsklinikum Jena und Medizinische Fakultät
Lila Bouadma, AP-HP Assistance Publique - Hopitaux de Paris
Michel Wolff, AP-HP Assistance Publique - Hopitaux de Paris
Jean Chastre, AP-HP Assistance Publique - Hopitaux de Paris
Charles Edouard Luyt, Sorbonne Universite
Florence Tubach, AP-HP Assistance Publique - Hopitaux de Paris
Angela R. Branche, Rochester Regional Health
Matthias Briel, Basel Institut für klinische Epidemiologie und Biostatistik
Mirjam Christ-Crain, Universitätsspital Basel
Tobias Welte, Medizinische Hochschule Hannover (MHH)
Caspar Corti, Københavns Universitet
Evelien de Jong, Amsterdam UMC - Vrije Universiteit Amsterdam
Maarten Nijsten, Universitair Medisch Centrum Groningen
Dylan W. de Lange, University Medical Center Utrecht
Jos A.H. van Oers, TweeSteden Hospital
Albertus Beishuizen, Medisch Spectrum Twente (MST)
Armand R.J. Girbes, Amsterdam UMC - Vrije Universiteit Amsterdam
Rodrigo O. Deliberato, Hospital Israelita Albert Einstein
Stefan Schroeder, Hospital Dueren
Kristina B. Kristoffersen, Aarhus Universitetshospital
Nathalie Layios, Centre Hospitalier Universitaire de Liege
Pierre Damas, Centre Hospitalier Universitaire de Liege
Stella S.S. Lima, Universidade Federal de Minas Gerais
Vandack Nobre, Universidade Federal de Minas Gerais
Long Wei, The Fifth People’s Hospital of Shanghai
Carolina F. Oliveira, Universidade Federal de Minas Gerais
Yahya Shehabi, Critical Care and Peri-operative Medicine
Daiana Stolz, Universitätsspital Basel
Michael Tamm, Universitätsspital Basel



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Age and ageing


BACKGROUND: Older patients have a less pronounced immune response to infection, which may also influence infection biomarkers. There is currently insufficient data regarding clinical effects of procalcitonin (PCT) to guide antibiotic treatment in older patients. OBJECTIVE AND DESIGN: We performed an individual patient data meta-analysis to investigate the association of age on effects of PCT-guided antibiotic stewardship regarding antibiotic use and outcome. SUBJECTS AND METHODS: We had access to 9,421 individual infection patients from 28 randomized controlled trials comparing PCT-guided antibiotic therapy (intervention group) or standard care. We stratified patients according to age in four groups (<75 years [n = 7,079], 75-80 years [n = 1,034], 81-85 years [n = 803] and >85 years [n = 505]). The primary endpoint was the duration of antibiotic treatment and the secondary endpoints were 30-day mortality and length of stay. RESULTS: Compared to control patients, mean duration of antibiotic therapy in PCT-guided patients was significantly reduced by 24, 22, 26 and 24% in the four age groups corresponding to adjusted differences in antibiotic days of -1.99 (95% confidence interval [CI] -2.36 to -1.62), -1.98 (95% CI -2.94 to -1.02), -2.20 (95% CI -3.15 to -1.25) and - 2.10 (95% CI -3.29 to -0.91) with no differences among age groups. There was no increase in the risk for mortality in any of the age groups. Effects were similar in subgroups by infection type, blood culture result and clinical setting (P interaction >0.05). CONCLUSIONS: This large individual patient data meta-analysis confirms that, similar to younger patients, PCT-guided antibiotic treatment in older patients is associated with significantly reduced antibiotic exposures and no increase in mortality.

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