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Effect of Procalcitonin-Guided Treatment in Patients with Infections: a Systematic Review and Meta-Analysis

  • Clinical and Epidemiological Study
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Abstract

Objective:

The aim of this study was to review the effectiveness of procalcitonin (PCT)-guided therapy in comparison to standard therapy in patients with suspected or confirmed bacterial infections in terms of antibiotic prescription at inclusion, duration of antibiotic therapy, total antibiotic exposure days/1,000 days, length of stay in the intensive care unit (ICU), length of stay in the hospital, and mortality.

Methods:

MEDLINE, EMBASE, Web of Science, and the Cochrane central register of controlled trials were searched up to November 2008. Studies considered to be eligible were randomized controlled trials comparing PCT-guided therapy with standard therapy in adult patients with bacterial infections. No language restriction was applied. Data were combined in a meta-analysis using random-effect models.

Results:

Seven studies with 1,458 patients were included. PCT-guided therapy was associated with a significant reduction in antibiotic prescription at inclusion (four studies; pooled odds ratio [OR] 0.506, 95% confidence interval [CI] 0.290–0.882, p = 0.016), duration of antibiotic therapy (six studies; weighted mean difference [WMD] 2.785, 95% CI 1.225–4.345, p = 0.000), total antibiotic exposure days/1,000 days (four studies; pooled relative risk [RR] 1.664, 95% CI 1.155–2.172, p = 0.000), and length of stay in the ICU (three studies; 292 patients; pooled WMD 3.49 days, 95% CI 1.28–5.70, p = 0.002). There were no significant differences in length of stay in the hospital (three studies; pooled WMD 1.003, 95% CI –0.430 to 2.437, p = 0.17) and mortality (seven studies; pooled OR 0.838, 95% CI 0.571–1.229, p = 0.365).

Conclusions:

Based on the results of this meta-analysis, it would appear that an algorithm based on serial PCT measurements would allow a more judicious use of antibiotics than currently occurs during the traditional treatment of patients with infections. PCT-guided antibiotic treatment appears to be safe and may also improve clinical outcome.

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Authors and Affiliations

  1. Intensive Care Unit, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road #88, 310009, Hangzhou, Zhejiang, People’s Republic of China

    H. Tang, T. Huang, J. Jing & W. Cui

  2. Dept. of Respiratory Disease, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China

    H. Shen

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  1. H. Tang
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  2. T. Huang
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  3. J. Jing
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  4. H. Shen
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  5. W. Cui
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Corresponding author

Correspondence to J. Jing.

Additional information

H. Tang and T. Huang contributed equally to this work.

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Tang, H., Huang, T., Jing, J. et al. Effect of Procalcitonin-Guided Treatment in Patients with Infections: a Systematic Review and Meta-Analysis. Infection 37, 497–507 (2009). https://doi.org/10.1007/s15010-009-9034-2

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  • DOI: https://doi.org/10.1007/s15010-009-9034-2

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