Procalcitonin to Guide Initiation and Duration of Antibiotic Treatment in Acute Respiratory Infections: An Individual Patient Data Meta-Analysis

被引：209

作者：

Schuetz, Philipp ^{[1
,2
,7
]}

Briel, Matthias ^{[4
,8
]}

Christ-Crain, Mirjam ^{[3
]}

Stolz, Daiana ^{[5
]}

Bouadma, Lila ^{[9
]}

Wolff, Michel ^{[9
]}

Luyt, Charles-Edouard ^{[10
]}

Chastre, Jean ^{[10
]}

Tubach, Florence ^{[11
,12
,13
,14
]}

Kristoffersen, Kristina B. ^{[15
]}

Wei, Long ^{[16
]}

Burkhardt, Olaf ^{[17
]}

Welte, Tobias ^{[17
]}

Schroeder, Stefan ^{[18
]}

Nobre, Vandack ^{[6
]}

Tamm, Michael ^{[5
]}

Bhatnagar, Neera ^{[8
]}

Bucher, Heiner C. ^{[4
]}

Mueller, Beat ^{[7
]}

机构：

[1] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA

[2] Beth Israel Deaconess Med Ctr, Dept Emergency Med, Boston, MA 02215 USA

[3] Univ Basel Hosp, Div Endocrinol Diabetol & Clin Nutr, Aarau, Switzerland

[4] Univ Basel Hosp, Basel Inst Clin Epidemiol & Biostat, Aarau, Switzerland

[5] Univ Basel Hosp, Clin Pneumol & Pulm Cell Res, Aarau, Switzerland

[6] Univ Hosp Geneva, Aarau, Switzerland

[7] Univ Basel, Med Univ Dept, Fac Med, Kantonsspital, Aarau, Switzerland

[8] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada

[9] Univ Paris 07, Hop Bichat Claude Bernard, AP HP, Serv Reanimat Med, Paris, France

[10] Univ Paris 06, Hop La Pitie Salpetriere, AP HP, Serv Reanimat Med,EA3964, Paris, France

[11] Hop Bichat Claude Bernard, AP HP, Dept Epidemiol Biostat & Rech Clin, F-75877 Paris, France

[12] Univ Paris Diderot, UMR 738, Paris, France

[13] INSERM, UMR 738, Paris, France

[14] INSERM, CIE801, Paris, France

[15] Aarhus Univ Hosp, Dept Infect Dis, Aarhus, Denmark

[16] Shanghai Fifth Peoples Hosp, Dept Emergency Med, Shanghai, Peoples R China

[17] Hannover Med Sch, Dept Pulm Med, D-30623 Hannover, Germany

[18] Krankenhaus Dueren, Dept Anesthesiol & Intens Care Med, Duren, Germany

来源：

CLINICAL INFECTIOUS DISEASES | 2012年 / 55卷 / 05期

基金：

瑞士国家科学基金会;

关键词：

INTENSIVE-CARE PATIENTS; TRACT INFECTIONS; ANTIMICROBIAL THERAPY; GUIDANCE; REDUCTION; SEPSIS; STEWARDSHIP; ALGORITHMS; BRONCHITIS; PNEUMONIA;

D O I：

10.1093/cid/cis464

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. Procalcitonin algorithms may reduce antibiotic use for acute respiratory tract infections (ARIs). We undertook an individual patient data meta-analysis to assess safety of this approach in different ARI diagnoses and different clinical settings. Methods. We identified clinical trials in which patients with ARI were assigned to receive antibiotics based on a procalcitonin algorithm or usual care by searching the Cochrane Register, MEDLINE, and EMBASE. Individual patient data from 4221 adults with ARIs in 14 trials were verified and reanalyzed to assess risk of mortality and treatment failure-overall and within different clinical settings and types of ARIs. Results. Overall, there were 118 deaths in 2085 patients (5.7%) assigned to procalcitonin groups compared with 134 deaths in 2126 control patients (6.3%; adjusted odds ratio, 0.94; 95% confidence interval CI, .71-1.23)]. Treatment failure occurred in 398 procalcitonin group patients (19.1%) and in 466 control patients (21.9%; adjusted odds ratio, 0.82; 95% CI,.71-.97). Procalcitonin guidance was not associated with increased mortality or treatment failure in any clinical setting or ARI diagnosis. Total antibiotic exposure per patient was significantly reduced overall (median [interquartile range], from 8 [5-12] to 4 [0-8] days; adjusted difference in days, -3.47 [95% CI, -3.78 to -3.17]) and across all clinical settings and ARI diagnoses. Conclusions. Use of procalcitonin to guide initiation and duration of antibiotic treatment in patients with ARIs was effective in reducing antibiotic exposure across settings without an increase in the risk of mortality or treatment failure. Further high-quality trials are needed in critical-care patients.

引用

页码：651 / 662

页数：12

共 42 条

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