Marc A Meier1, Angela Branche2, Olivia L Neeser1, Yannick Wirz1, Sebastian Haubitz1, Lila Bouadma3, Michel Wolff3, Charles E Luyt4, Jean Chastre4, Florence Tubach5, Mirjam Christ-Crain6, Caspar Corti7, Jens-Ulrik S Jensen8,9, Rodrigo O Deliberato10, Kristina B Kristoffersen11, Pierre Damas12, Vandack Nobre13, Carolina F Oliveira14, Yahya Shehabi15,16, Daiana Stolz17, Michael Tamm17, Beat Mueller1,18, Philipp Schuetz1,18. 1. Medical University Department, Kantonsspital Aarau, Switzerland. 2. Department of Medicine, University of Rochester, Rochester General Hospital, New York. 3. Service de Réanimation Médicale, Université Paris 7-Denis-Diderot, Assistance Publique-Hôpitaux de Paris (AP-HP), France. 4. Service de Réanimation Médicale, Université Paris 6-Pierre-et-Marie-Curie, France. 5. Département d'Epidémiologie Biostatistique et Recherche Clinique, AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, France. 6. Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Switzerland. 7. Department of Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Denmark. 8. Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases and Rheumatology, Finsencentret, Rigshospitalet, University of Copenhagen, Denmark. 9. Department of Internal Medicine, Respiratory Medicine Section, Copenhagen University Hospital Herlev-Gentofte Hospital, Denmark. 10. Critical Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. 11. Department of Infectious Diseases, Aarhus University Hospital, Denmark. 12. Department of General Intensive Care, University Hospital of Liege, Domaine universitaire de Liège, Belgium. 13. Department of Intensive Care, Hospital das Clinicas, Belo Horizonte, Brazil. 14. Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. 15. Critical Care and Peri-operative Medicine, Monash Health, Melbourne, Victoria, Australia. 16. School of Clinical Sciences, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia. 17. Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Switzerland. 18. Faculty of Medicine, University of Basel, Switzerland.
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 receivingPCT-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.
RCT Entities:
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.
Authors: John E Schneider; Jonathan Romanowsky; Philipp Schuetz; Ivana Stojanovic; Henry K Cheng; Oliver Liesenfeld; Ljubomir Buturovic; Timothy E Sweeney Journal: J Health Econ Outcomes Res Date: 2020-04-29
Authors: Nick Daneman; Asgar H Rishu; Ruxandra L Pinto; Yaseen M Arabi; Deborah J Cook; Richard Hall; Shay McGuinness; John Muscedere; Rachael Parke; Steven Reynolds; Benjamin Rogers; Yahya Shehabi; Robert A Fowler Journal: BMJ Open Date: 2020-05-11 Impact factor: 2.692