Use of procalcitonin guidance reduces antibiotic duration in hospitalized patients

Reference

Elnajdy D, El-Dahiyat F. Antibiotics duration guided by biomarkers in hospitalized adult patients: a systematic review and meta-analysis. Infect Dis (Lond) 2022;54(6):387-402.

Synopsis

These authors searched multiple databases including PubMed and EMBASE to find randomized controlled trials that evaluated the use of procalcitonin (PCT) and C-reactive protein (CRP) in determining antibiotic duration in hospitalized adults. The authors outlined a search strategy, performed a risk of bias assessment for included studies, and extracted data using a predefined form. It was unclear whether these functions were performed independently by the individual authors. Overall, 27 studies were included in the systematic review (25 studies examined the use of PCT; only 2 evaluated the use of CRP), and 21 of these were included in the meta-analysis. The risk of bias was high in most of the studies due to lack of masking. The primary outcome was duration of antibiotic use in patients with sepsis or respiratory infections. Although PCT guidance resulted in statistically significant decreased duration of antibiotics in both sepsis and respiratory infections (standardized mean difference -0.59; 95% CI -0.85 to -0.33), there was high heterogeneity for this result. There were no significant differences in secondary outcomes of length of stay, 28-day mortality, or recurrence of infection. The use of PCT was, however, associated with reduced in-hospital mortality (odds ratio 0.62; 0.41 - 0.94). One of the 2 CRP studies also showed a statistically significant decrease in duration of antibiotics using CRP-guidance in critically ill patients. There were no effects of CRP use on any secondary outcomes.