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Review
. 2017 Nov;146(5):576-584.
doi: 10.4103/ijmr.IJMR_613_15.

A meta-analysis to assess usefulness of procalcitonin-guided antibiotic usage for decision making

Nusrat Shafiq  1 , Vikas Gautam  2 , Avaneesh Kumar Pandey  1 , Navjot Kaur  1 , Shubha Garg  2 , Harish Negi  1 , Sharonjeet Kaur  1 , Pallab Ray  2 , Samir Malhotra  1
Affiliations
Review

A meta-analysis to assess usefulness of procalcitonin-guided antibiotic usage for decision making

Nusrat Shafiq et al. Indian J Med Res. 2017 Nov.

Abstract

Background & objectives: Development of antibacterial resistance and its association with antibiotic overuse makes it necessary to identify a specific and sensitive biomarker for the diagnosis of bacterial infection and guiding antibiotic therapy. Procalcitonin (PCT), as a sepsis biomarker, may play a role in guiding antibiotics treatment in hospital settings. The aim of the current meta-analysis was to analyze the utility of PCT on various outcomes of interest in inpatients.

Methods: Different databases were searched for randomized controlled trials comparing PCT-guided therapy with standard therapy in admitted patients with bacterial infections. Twenty six articles were found suitable for full text search and of these, 16 studies were considered finally for data extraction.

Results: There were no significant differences found in total mortality [pooled odds ratio (OR) 1.04, 95% confidence interval (CI) 0.89-1.22, P=0.63], 28-day mortality (pooled OR 0.97, 95% CI 0.80-1.19, P=0.79), need of Intensive Care Unit admission (OR=0.80, 95% CI 0.59-1.09, P=0.16) and duration of stay in hospital (pooled mean difference -0.01, 95% CI -0.50-0.49, P=0.98) between treatment and control groups. PCT-guided treatment significantly decreased the duration of antibiotic treatment (pooled mean difference -2.79, 95% CI -3.52--2.06, P<0.00001).

Interpretation & conclusions: PCT-guided therapy significantly decreased antibiotics exposure and thus treatment cost. However, the hard endpoints did not demonstrate any significant benefits, possibly due to low power to detect differences and/or the presence of comorbidities.

Keywords: Antibiotics - emergency - Intensive Care Unit - meta-analysis - procalcitonin - ward setting.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Flow chart showing selection process of the studies.
Fig. 2
Fig. 2
Total mortality in patients and controls. M-H, Mantel Haenzel method.
Fig. 3
Fig. 3
Proportion of patients treated with antibiotics. M-H, Mantel Haenzel method.
Fig. 4
Fig. 4
Duration of antibiotic treatment. IV, intervariable
Fig. 5
Fig. 5
Antibiotic use per 1000 days of follow up. IV, intervariable
See this image and copyright information in PMC

Comment in

  • Procalcitonin-guided antibiotic usage - addressing heterogeneity in meta-analysis.
    Birajdar AR, Thatte UM, Gogtay NJ. Birajdar AR, et al. Indian J Med Res. 2018 Sep;148(3):348-349. doi: 10.4103/ijmr.IJMR_1235_18. Indian J Med Res. 2018. PMID: 30425229 Free PMC article. No abstract available.
  • Authors' Response.
    Shafiq N, Gautam V, Pandey AK, Kaur N, Garg S, Negi H, Kaur S, Ray P, Malhotra S. Shafiq N, et al. Indian J Med Res. 2018 Sep;148(3):349-350. doi: 10.4103/0971-5916.245302. Indian J Med Res. 2018. PMID: 30425230 Free PMC article. No abstract available.

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