Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | https://doi.org/10.1093/ageing/afab078 http://hdl.handle.net/1843/56657 https://orcid.org/0000-0001-6805-8944 https://orcid.org/0000-0002-8012-6548 https://orcid.org/0000-0001-7424-2705 https://orcid.org/0000-0002-1869-8828 https://orcid.org/0000-0002-7922-0422 |
Resumo: | Background: Older patients have a less pronounced immune response to infection, which may also influence infection biomarkers. There is currently insufficient data regarding clinical effects of procalcitonin (PCT) to guide antibiotic treatment in older patients. Objective and design: We performed an individual patient data meta-analysis to investigate the association of age on effects of PCT-guided antibiotic stewardship regarding antibiotic use and outcome. Subjects and methods: We had access to 9,421 individual infection patients from 28 randomized controlled trials comparing PCT-guided antibiotic therapy (intervention group) or standard care. We stratified patients according to age in four groups (<75 years [n = 7,079], 75–80 years [n = 1,034], 81–85 years [n = 803] and >85 years [n = 505]). The primary endpoint was the duration of antibiotic treatment and the secondary endpoints were 30-day mortality and length of stay. Results: Compared to control patients, mean duration of antibiotic therapy in PCT-guided patients was significantly reduced by 24, 22, 26 and 24% in the four age groups corresponding to adjusted differences in antibiotic days of −1.99 (95% confidence interval [CI] −2.36 to −1.62), −1.98 (95% CI −2.94 to −1.02), −2.20 (95% CI −3.15 to −1.25) and − 2.10 (95% CI −3.29 to −0.91) with no differences among age groups. There was no increase in the risk for mortality in any of the age groups. Effects were similar in subgroups by infection type, blood culture result and clinical setting (P interaction >0.05). Conclusions: This large individual patient data meta-analysis confirms that, similar to younger patients, PCT-guided antibiotic treatment in older patients is associated with significantly reduced antibiotic exposures and no increase in mortality. |
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2023-07-18T20:44:01Z2023-07-18T20:44:01Z2021505https://doi.org/10.1093/ageing/afab0781468-2834http://hdl.handle.net/1843/56657https://orcid.org/0000-0001-6805-8944https://orcid.org/0000-0002-8012-6548https://orcid.org/0000-0001-7424-2705https://orcid.org/0000-0002-1869-8828https://orcid.org/0000-0002-7922-0422Background: Older patients have a less pronounced immune response to infection, which may also influence infection biomarkers. There is currently insufficient data regarding clinical effects of procalcitonin (PCT) to guide antibiotic treatment in older patients. Objective and design: We performed an individual patient data meta-analysis to investigate the association of age on effects of PCT-guided antibiotic stewardship regarding antibiotic use and outcome. Subjects and methods: We had access to 9,421 individual infection patients from 28 randomized controlled trials comparing PCT-guided antibiotic therapy (intervention group) or standard care. We stratified patients according to age in four groups (<75 years [n = 7,079], 75–80 years [n = 1,034], 81–85 years [n = 803] and >85 years [n = 505]). The primary endpoint was the duration of antibiotic treatment and the secondary endpoints were 30-day mortality and length of stay. Results: Compared to control patients, mean duration of antibiotic therapy in PCT-guided patients was significantly reduced by 24, 22, 26 and 24% in the four age groups corresponding to adjusted differences in antibiotic days of −1.99 (95% confidence interval [CI] −2.36 to −1.62), −1.98 (95% CI −2.94 to −1.02), −2.20 (95% CI −3.15 to −1.25) and − 2.10 (95% CI −3.29 to −0.91) with no differences among age groups. There was no increase in the risk for mortality in any of the age groups. Effects were similar in subgroups by infection type, blood culture result and clinical setting (P interaction >0.05). Conclusions: This large individual patient data meta-analysis confirms that, similar to younger patients, PCT-guided antibiotic treatment in older patients is associated with significantly reduced antibiotic exposures and no increase in mortality.Introdução: Pacientes mais velhos têm uma resposta imune menos pronunciada à infecção, o que também pode influenciar a infecção biomarcadores. Atualmente, não há dados suficientes sobre os efeitos clínicos da procalcitonina (PCT) para orientar o tratamento com antibióticos em pacientes mais velhos. Objetivo e projeto: Realizamos uma meta-análise de dados de pacientes individuais para investigar a associação da idade nos efeitos da administração de antibióticos guiada por PCT em relação ao uso e resultado de antibióticos. Sujeitos e métodos: Tivemos acesso a 9.421 pacientes com infecção individual de 28 ensaios clínicos randomizados comparando terapia antibiótica guiada por PCT (grupo de intervenção) ou tratamento padrão. Estratificamos os pacientes de acordo com a idade em quatro grupos (<75 anos [n = 7.079], 75–80 anos [n = 1.034], 81–85 anos [n = 803] e >85 anos [n = 505]). O endpoint primário foi a duração do tratamento com antibióticos e os endpoints secundários foram mortalidade em 30 dias e tempo de internação. Resultados: Em comparação com pacientes de controle, a duração média da antibioticoterapia em pacientes guiados por PCT foi significativamente reduzida em 24, 22, 26 e 24% nas quatro faixas etárias, correspondendo a diferenças ajustadas nos dias de antibióticos de -1,99 (intervalo de confiança de 95% [ CI] −2,36 a −1,62), −1,98 (IC 95% −2,94 a −1,02), −2,20 (IC 95% −3,15 a −1,25) e − 2,10 (IC 95% −3,29 a −0,91) sem diferenças entre as faixas etárias. Não houve aumento do risco de mortalidade em nenhuma das faixas etárias. Os efeitos foram semelhantes em subgrupos por tipo de infecção, resultado da hemocultura e quadro clínico (interação P >0,05). Conclusões: Esta grande meta-análise de dados de pacientes individuais confirma que, semelhante aos pacientes mais jovens, o tratamento antibiótico guiado por PCT em pacientes mais velhos está associado a exposições antibióticas significativamente reduzidas e sem aumento na mortalidade.engUniversidade Federal de Minas GeraisUFMGBrasilMED - DEPARTAMENTO DE CLÍNICA MÉDICAAge and AgeingFatores etáriosIdosoPró-calcitoninaGestão de antimicrobianosAgeOlder patientsProcalcitoninAntibiotic stewardshipDuration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trialsDuração do tratamento com antibióticos usando algoritmos de tratamento guiados por procalcitonina em pacientes idosos: uma metanálise em nível de paciente a partir de estudos randomizados controladosinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://academic.oup.com/ageing/article/50/5/1546/6276251Eva HeilmannClaudia GregorianoDjillali AnnaneKonrad ReinhartLila BouadmaMichel WolffJean ChastreCharles-Edouard LuytFlorence TubachAngela R. BrancheMatthias BrielMirjam Christ-CrainTobias WelteCaspar CortiEvelien de JongMaarten NijstenDylan W. de LangeJos A.H. van OersAlbertus BeishuizenArmand R. J. GirbesRodrigo Octávio DeliberatoStefan SchroederKristina B. KristoffersenNathalie LayiosPierre DamasStella S. S. LimaVandack NobreLong WeiCarolina F. OliveiraYahya ShehabiDaiana StolzMichael TammAlessia VerduriJin-Xiang WangSabine DrevetGaetan GavazziBeat MuellerPhilipp Schuetzapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/56657/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALDuration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients_ a patient-level meta-analysis from randomized controlled trials .pdfDuration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients_ a patient-level meta-analysis from randomized controlled trials .pdfapplication/pdf545815https://repositorio.ufmg.br/bitstream/1843/56657/2/Duration%20of%20antibiotic%20treatment%20using%20procalcitonin-guided%20treatment%20algorithms%20in%20older%20patients_%20a%20patient-level%20meta-analysis%20from%20randomized%20controlled%20trials%20.pdf7ac1fc5cd71a2aeeb90e9fc7a7e0f93bMD521843/566572023-07-18 17:44:02.218oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-07-18T20:44:02Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials |
dc.title.alternative.pt_BR.fl_str_mv |
Duração do tratamento com antibióticos usando algoritmos de tratamento guiados por procalcitonina em pacientes idosos: uma metanálise em nível de paciente a partir de estudos randomizados controlados |
title |
Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials |
spellingShingle |
Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials Eva Heilmann Age Older patients Procalcitonin Antibiotic stewardship Fatores etários Idoso Pró-calcitonina Gestão de antimicrobianos |
title_short |
Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials |
title_full |
Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials |
title_fullStr |
Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials |
title_full_unstemmed |
Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials |
title_sort |
Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials |
author |
Eva Heilmann |
author_facet |
Eva Heilmann Claudia Gregoriano Djillali Annane Konrad Reinhart Lila Bouadma Michel Wolff Jean Chastre Charles-Edouard Luyt Florence Tubach Angela R. Branche Matthias Briel Mirjam Christ-Crain Tobias Welte Caspar Corti Evelien de Jong Maarten Nijsten Dylan W. de Lange Jos A.H. van Oers Albertus Beishuizen Armand R. J. Girbes Rodrigo Octávio Deliberato Stefan Schroeder Kristina B. Kristoffersen Nathalie Layios Pierre Damas Stella S. S. Lima Vandack Nobre Long Wei Carolina F. Oliveira Yahya Shehabi Daiana Stolz Michael Tamm Alessia Verduri Jin-Xiang Wang Sabine Drevet Gaetan Gavazzi Beat Mueller Philipp Schuetz |
author_role |
author |
author2 |
Claudia Gregoriano Djillali Annane Konrad Reinhart Lila Bouadma Michel Wolff Jean Chastre Charles-Edouard Luyt Florence Tubach Angela R. Branche Matthias Briel Mirjam Christ-Crain Tobias Welte Caspar Corti Evelien de Jong Maarten Nijsten Dylan W. de Lange Jos A.H. van Oers Albertus Beishuizen Armand R. J. Girbes Rodrigo Octávio Deliberato Stefan Schroeder Kristina B. Kristoffersen Nathalie Layios Pierre Damas Stella S. S. Lima Vandack Nobre Long Wei Carolina F. Oliveira Yahya Shehabi Daiana Stolz Michael Tamm Alessia Verduri Jin-Xiang Wang Sabine Drevet Gaetan Gavazzi Beat Mueller Philipp Schuetz |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Eva Heilmann Claudia Gregoriano Djillali Annane Konrad Reinhart Lila Bouadma Michel Wolff Jean Chastre Charles-Edouard Luyt Florence Tubach Angela R. Branche Matthias Briel Mirjam Christ-Crain Tobias Welte Caspar Corti Evelien de Jong Maarten Nijsten Dylan W. de Lange Jos A.H. van Oers Albertus Beishuizen Armand R. J. Girbes Rodrigo Octávio Deliberato Stefan Schroeder Kristina B. Kristoffersen Nathalie Layios Pierre Damas Stella S. S. Lima Vandack Nobre Long Wei Carolina F. Oliveira Yahya Shehabi Daiana Stolz Michael Tamm Alessia Verduri Jin-Xiang Wang Sabine Drevet Gaetan Gavazzi Beat Mueller Philipp Schuetz |
dc.subject.por.fl_str_mv |
Age Older patients Procalcitonin Antibiotic stewardship |
topic |
Age Older patients Procalcitonin Antibiotic stewardship Fatores etários Idoso Pró-calcitonina Gestão de antimicrobianos |
dc.subject.other.pt_BR.fl_str_mv |
Fatores etários Idoso Pró-calcitonina Gestão de antimicrobianos |
description |
Background: Older patients have a less pronounced immune response to infection, which may also influence infection biomarkers. There is currently insufficient data regarding clinical effects of procalcitonin (PCT) to guide antibiotic treatment in older patients. Objective and design: We performed an individual patient data meta-analysis to investigate the association of age on effects of PCT-guided antibiotic stewardship regarding antibiotic use and outcome. Subjects and methods: We had access to 9,421 individual infection patients from 28 randomized controlled trials comparing PCT-guided antibiotic therapy (intervention group) or standard care. We stratified patients according to age in four groups (<75 years [n = 7,079], 75–80 years [n = 1,034], 81–85 years [n = 803] and >85 years [n = 505]). The primary endpoint was the duration of antibiotic treatment and the secondary endpoints were 30-day mortality and length of stay. Results: Compared to control patients, mean duration of antibiotic therapy in PCT-guided patients was significantly reduced by 24, 22, 26 and 24% in the four age groups corresponding to adjusted differences in antibiotic days of −1.99 (95% confidence interval [CI] −2.36 to −1.62), −1.98 (95% CI −2.94 to −1.02), −2.20 (95% CI −3.15 to −1.25) and − 2.10 (95% CI −3.29 to −0.91) with no differences among age groups. There was no increase in the risk for mortality in any of the age groups. Effects were similar in subgroups by infection type, blood culture result and clinical setting (P interaction >0.05). Conclusions: This large individual patient data meta-analysis confirms that, similar to younger patients, PCT-guided antibiotic treatment in older patients is associated with significantly reduced antibiotic exposures and no increase in mortality. |
publishDate |
2021 |
dc.date.issued.fl_str_mv |
2021 |
dc.date.accessioned.fl_str_mv |
2023-07-18T20:44:01Z |
dc.date.available.fl_str_mv |
2023-07-18T20:44:01Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/56657 |
dc.identifier.doi.pt_BR.fl_str_mv |
https://doi.org/10.1093/ageing/afab078 |
dc.identifier.issn.pt_BR.fl_str_mv |
1468-2834 |
dc.identifier.orcid.pt_BR.fl_str_mv |
https://orcid.org/0000-0001-6805-8944 https://orcid.org/0000-0002-8012-6548 https://orcid.org/0000-0001-7424-2705 https://orcid.org/0000-0002-1869-8828 https://orcid.org/0000-0002-7922-0422 |
url |
https://doi.org/10.1093/ageing/afab078 http://hdl.handle.net/1843/56657 https://orcid.org/0000-0001-6805-8944 https://orcid.org/0000-0002-8012-6548 https://orcid.org/0000-0001-7424-2705 https://orcid.org/0000-0002-1869-8828 https://orcid.org/0000-0002-7922-0422 |
identifier_str_mv |
1468-2834 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.pt_BR.fl_str_mv |
Age and Ageing |
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info:eu-repo/semantics/openAccess |
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openAccess |
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application/pdf |
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Universidade Federal de Minas Gerais |
dc.publisher.initials.fl_str_mv |
UFMG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
MED - DEPARTAMENTO DE CLÍNICA MÉDICA |
publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
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reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
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