Authors:
Procalcitonin guidance for antibiotic cessation improves short-term mortality in ICU patients. Previous meta-analyses showed that procalcitonin-guided antimicrobial management, compared with standard care, resulted in less overall antibiotic exposure in intensive care unit (ICU) patients; however, differences in mortality or length of stay were not detected (NEJM JW Hosp Med Oct 2011 and Crit Care Med 2011; 39:1792). In a new meta-analysis, researchers evaluated data from 15 randomized, controlled trials (>6000 intensive care unit [ICU] patients, and including 2 large recent trials that were not available in previous meta-analyses) that used procalcitonin as a marker of new or ongoing bacterial infection. Procalcitonin-guided strategies used in the trials were categorized into phases of antimicrobial use: initiation, cessation, or mixed (combined initiation and cessation). Procalcitonin-guided antibiotic cessation significantly lowered short-term (in-hospital or 30-day) mortality (21% vs. 24%, number needed to treat, 32) and antibiotic duration (mean difference, 1.3 days), but did not affect hospital or ICU length of stay. Procalcitonin-guided initiation or mixed strategies did not affect short-term mortality. |
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A procalcitonin-guided strategy benefits critically ill patients when applied to managing antibiotic cessation in ICU patients. Adherence to procalcitonin protocols is required, including (in some protocols) drawing an initial procalcitonin level at ICU admission or at presumed infection onset and drawing follow-up levels, with antibiotic cessation versus continuation determined by procalcitonin level changes or absolute levels. Clinicians should not use procalcitonin to guide antibiotic initiation in ICU patients.