Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: a patient-level meta-analysis from randomized controlled trials.
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ therapeutic use
Antimicrobial Stewardship
Biomarkers
/ blood
Drug Utilization
Female
Hospitalization
Humans
Kidney
Length of Stay
Male
Middle Aged
Mortality
/ ethnology
Practice Guidelines as Topic
Procalcitonin
/ blood
Randomized Controlled Trials as Topic
Renal Insufficiency, Chronic
/ mortality
Risk Assessment
Time Factors
Treatment Outcome
antibiotic stewardship
chronic kidney disease
procalcitonin
Journal
Clinical chemistry and laboratory medicine
ISSN: 1437-4331
Titre abrégé: Clin Chem Lab Med
Pays: Germany
ID NLM: 9806306
Informations de publication
Date de publication:
28 09 2020
28 09 2020
Historique:
received:
17
06
2020
accepted:
31
08
2020
pubmed:
29
9
2020
medline:
22
9
2021
entrez:
28
9
2020
Statut:
epublish
Résumé
Patients with impaired kidney function have a significantly slower decrease of procalcitonin (PCT) levels during infection. Our aim was to study PCT-guided antibiotic stewardship and clinical outcomes in patients with impairments of kidney function as assessed by creatinine levels measured upon hospital admission. We pooled and analyzed individual data from 15 randomized controlled trials who were randomly assigned to receive antibiotic therapy based on a PCT-algorithms or based on standard of care. We stratified patients on the initial glomerular filtration rate (GFR, ml/min/1.73 m2) in three groups (GFR >90 [chronic kidney disease; CKD 1], GFR 15-89 [CKD 2-4] and GFR<15 [CKD 5]). The main efficacy and safety endpoints were duration of antibiotic treatment and 30-day mortality. Mean duration of antibiotic treatment was significantly shorter in PCT-guided (n=2,492) compared to control patients (n=2,510) (9.5-7.6 days; adjusted difference in days -2.01 [95% CI, -2.45 to -1.58]). CKD 5 patients had overall longer treatment durations, but a 2.5-day reduction in treatment duration was still found in patients receiving in PCT-guided care (11.3 vs. 8.6 days [95% CI -3.59 to -1.40]). There were 397 deaths in 2,492 PCT-group patients (15.9%) compared to 460 deaths in 2,510 control patients (18.3%) (adjusted odds ratio, 0.88 [95% CI 0.78 to 0.98)]. Effects of PCT-guidance on antibiotic treatment duration and mortality were similar in subgroups stratified by infection type and clinical setting (p interaction >0.05). This individual patient data meta-analysis confirms that the use of PCT in patients with impaired kidney function, as assessed by admission creatinine levels, is associated with shorter antibiotic courses and lower mortality rates.
Identifiants
pubmed: 32986609
doi: 10.1515/cclm-2020-0931
pii: cclm-2020-0931
doi:
Substances chimiques
Anti-Bacterial Agents
0
Biomarkers
0
Procalcitonin
0
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
441-453Références
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