Procalcitonin-guided Antibiotic Treatment in Patients With Positive Blood Cultures: A Patient-level Meta-analysis of Randomized Trials

Marc A. Meier, Medical University Department, Kantonsspital Aarau, Switzerland.
Angela Branche, Rochester Regional Health
Olivia L. Neeser, Medical University Department, Kantonsspital Aarau, Switzerland.
Yannick Wirz, Medical University Department, Kantonsspital Aarau, Switzerland.
Sebastian Haubitz, Medical University Department, Kantonsspital Aarau, Switzerland.
Lila Bouadma, Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique-Hôpitaux de Paris (AP-HP), France.
Michel Wolff, Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique-Hôpitaux de Paris (AP-HP), France.
Charles E. Luyt, Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, France.
Jean Chastre, Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, France.
Florence Tubach, Département d'Epidémiologie Biostatistique et Recherche Clinique, AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, France.
Mirjam Christ-Crain, Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Switzerland.
Caspar Corti, Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Denmark.
Jens-Ulrik S. Jensen, Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases and Rheumatology, Finsencentret, Rigshospitalet, University of Copenhagen, Denmark.
Rodrigo O. Deliberato, Critical Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Kristina B. Kristoffersen, Department of Infectious Diseases, Aarhus University Hospital, Denmark.
Pierre Damas, Department of General Intensive Care, University Hospital of Liege, Domaine universitaire de Liège, Belgium.
Vandack Nobre, Department of Intensive Care, Hospital das Clinicas, Belo Horizonte, Brazil.
Carolina F. Oliveira, Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Yahya Shehabi, Critical Care and Peri-operative Medicine, Monash Health, Melbourne, Victoria, Australia.
Daiana Stolz, Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Switzerland.
Michael Tamm, Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Switzerland.
Beat Mueller, Medical University Department, Kantonsspital Aarau, Switzerland.
Philipp Schuetz, Medical University Department, Kantonsspital Aarau, Switzerland.

Department

Medicine

Document Type

Article

Publication Title

Clinical Infectious Diseases

Abstract

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

First Page

388

Last Page

396

DOI

10.1093/cid/ciy917

Volume

69

Issue

3

Publication Date

7-18-2019

Medical Subject Headings

Anti-Bacterial Agents (therapeutic use); Antimicrobial Stewardship (methods); Bacteremia (drug therapy, mortality); Biomarkers (blood); Blood Culture; Disease Management; Escherichia coli (drug effects); Escherichia coli Infections (drug therapy); Humans; Intensive Care Units; Pneumococcal Infections (drug therapy); Procalcitonin (blood); Randomized Controlled Trials as Topic; Streptococcus pneumoniae (drug effects)

PubMed ID

30358811

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