Procalcitonin-guided therapy in respiratory tract infections: a meta-analysis and systematic review.
Antimicrob Agents Chemother. 2011 Sep 26;
Authors: Li H, Luo YF, Blackwell TS, Xie CM
Circulating procalcitonin (PCT) is a biomarker that can be used in diagnosing bacterial infections. We performed a quantitative meta-analysis of available randomized controlled trials to determine whether antibiotic therapy based on PCT measurements alters clinical outcomes and antibiotic use in patients with lower respiratory tract infections. We identified studies through MEDLINE (1996-2010), IS Web of knowledge (1996-2010), and OVID. Studies that met our criteria were prospective, randomized controlled trials involving patients with respiratory tract infections. Outcomes of mortality, ICU admission, length of hospital stay, number of antibiotic prescriptions, and duration of antibiotic treatment were evaluated. Eight studies randomizing 3431 patients met our criteria for inclusion. Pooled analysis showed a significant reduction in number of antibiotic prescriptions and duration of antibiotic use in patients with PCT-guided antibiotic treatment compared to standard therapy. In addition, the use of PCT-guided antibiotic therapy did not impact mortality, ICU admission, or hospital stay in these studies. A high degree of heterogeneity was identified in 3 of 5 outcomes that were evaluated and sensitivity analysis indicated that heterogeneity was decreased among studies using the same PCT based treatment algorithm. In conclusion, PCT-guided antibiotic therapy in patients with respiratory tract infections appears to reduce antibiotic use without affecting overall mortality or length of stay in the hospital.
PMID: 21947386 [PubMed - as supplied by publisher]