Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | http://hdl.handle.net/1843/42632 |
Resumo: | Background In February, 2017, the US Food and Drug Administration approved the blood infection marker procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety of procalcitonin-guided treatment in patients with acute respiratory infections from different clinical settings. Methods Based on a prespecified Cochrane protocol, we did a systematic literature search on the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, and pooled individual patient data from trials in which patients with respiratory infections were randomly assigned to receive antibiotics based on procalcitonin concentrations (procalcitonin-guided group) or control. The coprimary endpoints were 30-day mortality and setting-specific treatment failure. Secondary endpoints were antibiotic use, length of stay, and antibiotic side-effects. Findings We identified 990 records from the literature search, of which 71 articles were assessed for eligibility after exclusion of 919 records. We collected data on 6708 patients from 26 eligible trials in 12 countries. Mortality at 30 days was significantly lower in procalcitonin-guided patients than in control patients (286 [9%] deaths in 3336 procalcitonin guided patients vs 336 [10%] in 3372 controls; adjusted odds ratio [OR] 0·83 [95% CI 0·70 to 0·99], p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (pinteractions>0·05), although mortality was very low in primary care and in patients with acute bronchitis. Procalcitonin guidance was also associated with a 2·4-day reduction in antibiotic exposure (5·7 vs 8·1 days [95% CI –2·71 to –2·15], p<0·0001) and a reduction in antibiotic-related side-effects (16% vs 22%, adjusted OR 0·68 [95% CI 0·57 to 0·82], p<0·0001). Interpretation Use of procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance. |
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2022-06-23T21:50:32Z2022-06-23T21:50:32Z201717110.1016/s1473-3099(17)30592-31473-3099http://hdl.handle.net/1843/42632Background In February, 2017, the US Food and Drug Administration approved the blood infection marker procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety of procalcitonin-guided treatment in patients with acute respiratory infections from different clinical settings. Methods Based on a prespecified Cochrane protocol, we did a systematic literature search on the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, and pooled individual patient data from trials in which patients with respiratory infections were randomly assigned to receive antibiotics based on procalcitonin concentrations (procalcitonin-guided group) or control. The coprimary endpoints were 30-day mortality and setting-specific treatment failure. Secondary endpoints were antibiotic use, length of stay, and antibiotic side-effects. Findings We identified 990 records from the literature search, of which 71 articles were assessed for eligibility after exclusion of 919 records. We collected data on 6708 patients from 26 eligible trials in 12 countries. Mortality at 30 days was significantly lower in procalcitonin-guided patients than in control patients (286 [9%] deaths in 3336 procalcitonin guided patients vs 336 [10%] in 3372 controls; adjusted odds ratio [OR] 0·83 [95% CI 0·70 to 0·99], p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (pinteractions>0·05), although mortality was very low in primary care and in patients with acute bronchitis. Procalcitonin guidance was also associated with a 2·4-day reduction in antibiotic exposure (5·7 vs 8·1 days [95% CI –2·71 to –2·15], p<0·0001) and a reduction in antibiotic-related side-effects (16% vs 22%, adjusted OR 0·68 [95% CI 0·57 to 0·82], p<0·0001). Interpretation Use of procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance.Antecedentes Em fevereiro de 2017, a Food and Drug Administration dos EUA aprovou o marcador de infecção no sangue procalcitonina para orientar a antibioticoterapia em pacientes com infecções respiratórias agudas. Esta meta-análise de pacientes dados de 26 ensaios clínicos randomizados foram projetados para avaliar a segurança do tratamento guiado por procalcitonina em pacientes com infecções respiratórias agudas de diferentes contextos clínicos. Métodos Com base em um protocolo Cochrane pré-especificado, fizemos uma busca sistemática na literatura no Cochrane Central Registro de Ensaios Controlados, MEDLINE e Embase, e dados de pacientes individuais agrupados de ensaios nos quais os pacientes com infecções respiratórias foram aleatoriamente designados para receber antibióticos com base nas concentrações de procalcitonina (grupo guiado por procalcitonina) ou controle. Os desfechos coprimários foram mortalidade em 30 dias e tratamento específico do cenário fracasso. Os desfechos secundários foram o uso de antibióticos, o tempo de internação e os efeitos colaterais dos antibióticos. Resultados Identificamos 990 registros da busca na literatura, dos quais 71 artigos foram avaliados para elegibilidade após exclusão de 919 registros. Coletamos dados de 6.708 pacientes de 26 estudos elegíveis em 12 países. Mortalidade em 30 dias foi significativamente menor em pacientes guiados por procalcitonina do que em pacientes controle (286 [9%] mortes em 3.336 pacientes guiados por procalcitonina vs 336 [10%] em 3.372 controles; razão de chances ajustada [OR] 0,83 [IC 95% 0· 70 a 0,99], p=0,037). Esse O benefício de mortalidade foi semelhante entre os subgrupos por configuração e tipo de infecção (interações>0,05), embora a mortalidade tenha sido muito baixa na atenção primária e em pacientes com bronquite aguda. A orientação da procalcitonina também foi associada a um Redução de 2,4 dias na exposição ao antibiótico (5,7 vs 8,1 dias [IC 95% –2,71 a –2,15], p<0,0001) e uma redução na efeitos colaterais relacionados ao antibiótico (16% vs 22%, ajustado OR 0,68 [IC 95% 0,57 a 0,82], p <0,0001). Interpretação O uso de procalcitonina para orientar o tratamento com antibióticos em pacientes com infecções respiratórias agudas reduz exposição a antibióticos e efeitos colaterais, e melhora a sobrevida. Implementação generalizada de protocolos de procalcitonina em pacientes com infecções respiratórias agudas, portanto, tem o potencial de melhorar o manejo de antibióticos com efeitos sobre os resultados clínicos e sobre a ameaça atual de aumentar a multirresistência aos antibióticos.engUniversidade Federal de Minas GeraisUFMGBrasilMED - DEPARTAMENTO DE CLÍNICA MÉDICALancet infectious diseasesProcalcitoninaInfecções respiratórias agudasEffect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysisEfeito do tratamento antibiótico guiado por procalcitonina na mortalidade em infecções respiratórias agudas: uma meta-análise em nível de pacienteinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30592-3/fulltextPhilipp SchuetzJean ChastreFlorence TubachKristina B. KristoffersenOlaf BurkhardtTobias WelteStefan SchroederVandack NobreLong WeiHeiner C. BucherDjillali AnnaneYannick WirzKonrad ReinhartAnn R. FalseyAngela BranchePierre DamasMaarten NijstenDylan W. de LangeRodrigo O. DeliberatoCarolina Ferreira de OliveiraVera Maravi'-Stojkovi'Alessia VerduriRamon SagerBianca BeghéBin CaoYahya ShehabiJens-Ulrik S. JensenCaspar CortiJos A. H. Van OersAlbertus BeishuizenArmand R. J. GirbesEvelien de JongMatthias BrielMirjam Christ-CrainBeat MuellerDaiana StolzMichael TammLila BouadmaCharles E. LuytMichel Wolffapplication/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/1843/42632/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINAL2017_Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections- a patient level meta-analysis.pdf2017_Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections- a patient level meta-analysis.pdfapplication/pdf817025https://repositorio.ufmg.br/bitstream/1843/42632/2/2017_Effect%20of%20procalcitonin-guided%20antibiotic%20treatment%20on%20mortality%20in%20acute%20respiratory%20infections-%20a%20patient%20level%20meta-analysis.pdf158f3e706acea3453ea59a68946d119cMD521843/426322022-06-23 18:50:32.343oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2022-06-23T21:50:32Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis |
dc.title.alternative.pt_BR.fl_str_mv |
Efeito do tratamento antibiótico guiado por procalcitonina na mortalidade em infecções respiratórias agudas: uma meta-análise em nível de paciente |
title |
Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis |
spellingShingle |
Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis Philipp Schuetz Procalcitonina Infecções respiratórias agudas |
title_short |
Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis |
title_full |
Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis |
title_fullStr |
Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis |
title_full_unstemmed |
Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis |
title_sort |
Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis |
author |
Philipp Schuetz |
author_facet |
Philipp Schuetz Jean Chastre Florence Tubach Kristina B. Kristoffersen Olaf Burkhardt Tobias Welte Stefan Schroeder Vandack Nobre Long Wei Heiner C. Bucher Djillali Annane Yannick Wirz Konrad Reinhart Ann R. Falsey Angela Branche Pierre Damas Maarten Nijsten Dylan W. de Lange Rodrigo O. Deliberato Carolina Ferreira de Oliveira Vera Maravi'-Stojkovi' Alessia Verduri Ramon Sager Bianca Beghé Bin Cao Yahya Shehabi Jens-Ulrik S. Jensen Caspar Corti Jos A. H. Van Oers Albertus Beishuizen Armand R. J. Girbes Evelien de Jong Matthias Briel Mirjam Christ-Crain Beat Mueller Daiana Stolz Michael Tamm Lila Bouadma Charles E. Luyt Michel Wolff |
author_role |
author |
author2 |
Jean Chastre Florence Tubach Kristina B. Kristoffersen Olaf Burkhardt Tobias Welte Stefan Schroeder Vandack Nobre Long Wei Heiner C. Bucher Djillali Annane Yannick Wirz Konrad Reinhart Ann R. Falsey Angela Branche Pierre Damas Maarten Nijsten Dylan W. de Lange Rodrigo O. Deliberato Carolina Ferreira de Oliveira Vera Maravi'-Stojkovi' Alessia Verduri Ramon Sager Bianca Beghé Bin Cao Yahya Shehabi Jens-Ulrik S. Jensen Caspar Corti Jos A. H. Van Oers Albertus Beishuizen Armand R. J. Girbes Evelien de Jong Matthias Briel Mirjam Christ-Crain Beat Mueller Daiana Stolz Michael Tamm Lila Bouadma Charles E. Luyt Michel Wolff |
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 author author |
dc.contributor.author.fl_str_mv |
Philipp Schuetz Jean Chastre Florence Tubach Kristina B. Kristoffersen Olaf Burkhardt Tobias Welte Stefan Schroeder Vandack Nobre Long Wei Heiner C. Bucher Djillali Annane Yannick Wirz Konrad Reinhart Ann R. Falsey Angela Branche Pierre Damas Maarten Nijsten Dylan W. de Lange Rodrigo O. Deliberato Carolina Ferreira de Oliveira Vera Maravi'-Stojkovi' Alessia Verduri Ramon Sager Bianca Beghé Bin Cao Yahya Shehabi Jens-Ulrik S. Jensen Caspar Corti Jos A. H. Van Oers Albertus Beishuizen Armand R. J. Girbes Evelien de Jong Matthias Briel Mirjam Christ-Crain Beat Mueller Daiana Stolz Michael Tamm Lila Bouadma Charles E. Luyt Michel Wolff |
dc.subject.other.pt_BR.fl_str_mv |
Procalcitonina Infecções respiratórias agudas |
topic |
Procalcitonina Infecções respiratórias agudas |
description |
Background In February, 2017, the US Food and Drug Administration approved the blood infection marker procalcitonin for guiding antibiotic therapy in patients with acute respiratory infections. This meta-analysis of patient data from 26 randomised controlled trials was designed to assess safety of procalcitonin-guided treatment in patients with acute respiratory infections from different clinical settings. Methods Based on a prespecified Cochrane protocol, we did a systematic literature search on the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase, and pooled individual patient data from trials in which patients with respiratory infections were randomly assigned to receive antibiotics based on procalcitonin concentrations (procalcitonin-guided group) or control. The coprimary endpoints were 30-day mortality and setting-specific treatment failure. Secondary endpoints were antibiotic use, length of stay, and antibiotic side-effects. Findings We identified 990 records from the literature search, of which 71 articles were assessed for eligibility after exclusion of 919 records. We collected data on 6708 patients from 26 eligible trials in 12 countries. Mortality at 30 days was significantly lower in procalcitonin-guided patients than in control patients (286 [9%] deaths in 3336 procalcitonin guided patients vs 336 [10%] in 3372 controls; adjusted odds ratio [OR] 0·83 [95% CI 0·70 to 0·99], p=0·037). This mortality benefit was similar across subgroups by setting and type of infection (pinteractions>0·05), although mortality was very low in primary care and in patients with acute bronchitis. Procalcitonin guidance was also associated with a 2·4-day reduction in antibiotic exposure (5·7 vs 8·1 days [95% CI –2·71 to –2·15], p<0·0001) and a reduction in antibiotic-related side-effects (16% vs 22%, adjusted OR 0·68 [95% CI 0·57 to 0·82], p<0·0001). Interpretation Use of procalcitonin to guide antibiotic treatment in patients with acute respiratory infections reduces antibiotic exposure and side-effects, and improves survival. Widespread implementation of procalcitonin protocols in patients with acute respiratory infections thus has the potential to improve antibiotic management with positive effects on clinical outcomes and on the current threat of increasing antibiotic multiresistance. |
publishDate |
2017 |
dc.date.issued.fl_str_mv |
2017 |
dc.date.accessioned.fl_str_mv |
2022-06-23T21:50:32Z |
dc.date.available.fl_str_mv |
2022-06-23T21:50:32Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/42632 |
dc.identifier.doi.pt_BR.fl_str_mv |
10.1016/s1473-3099(17)30592-3 |
dc.identifier.issn.pt_BR.fl_str_mv |
1473-3099 |
identifier_str_mv |
10.1016/s1473-3099(17)30592-3 1473-3099 |
url |
http://hdl.handle.net/1843/42632 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.pt_BR.fl_str_mv |
Lancet infectious diseases |
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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 |
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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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