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

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Abstract
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. 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. 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). 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.