Procalcitonin-guided antibiotic treatment in patients with positive blood cultures: a patient-level meta-analysis of randomized trials
Autor(a) principal: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UFMG |
Texto Completo: | http://hdl.handle.net/1843/42635 |
Resumo: | Background Whether procalcitonin (PCT)–guided antibiotic management in patients with positive blood cultures is safe remains understudied. We performed a patient-level meta-analysis to investigate effects of PCT-guided antibiotic management in patients with bacteremia. Methods We extracted and analyzed individual data of 523 patients with positive blood cultures included in 13 trials, in which patients were randomly assigned to receive antibiotics based on PCT levels (PCT group) or a control group. The main efficacy endpoint was duration of antibiotic treatment. The main safety endpoint was mortality within 30 days. Results Mean duration of antibiotic therapy was significantly shorter for 253 patients who received PCT-guided treatment than for 270 control patients (–2.86 days [95% confidence interval [CI], –4.88 to –.84]; P = .006). Mortality was similar in both arms (16.6% vs 20.0%; P = .263). In subgroup analyses by type of pathogen, we noted a trend of shorter mean antibiotic durations in the PCT arm for patients infected with gram-positive organisms or Escherichia coli and significantly shorter treatment for subjects with pneumococcal bacteremia. In analysis by site of infection, antibiotic exposure was shortened in PCT subjects with Streptococcus pneumoniae respiratory infection and those with E. coli urogenital infections. Conclusions This meta-analysis of patients with bacteremia receiving PCT-guided antibiotic management demonstrates lower antibiotic exposure without an apparent increase in mortality. Few differences were demonstrated in subgroup analysis stratified by type or site of infection but notable for decreased exposure in patients with pneumococcal pneumonia and E. coli urogenital infections. |
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2022-06-23T21:53:56Z2022-06-23T21:53:56Z201969338839610.1093/cid/ciy9171058-4838http://hdl.handle.net/1843/42635Background Whether procalcitonin (PCT)–guided antibiotic management in patients with positive blood cultures is safe remains understudied. We performed a patient-level meta-analysis to investigate effects of PCT-guided antibiotic management in patients with bacteremia. Methods We extracted and analyzed individual data of 523 patients with positive blood cultures included in 13 trials, in which patients were randomly assigned to receive antibiotics based on PCT levels (PCT group) or a control group. The main efficacy endpoint was duration of antibiotic treatment. The main safety endpoint was mortality within 30 days. Results Mean duration of antibiotic therapy was significantly shorter for 253 patients who received PCT-guided treatment than for 270 control patients (–2.86 days [95% confidence interval [CI], –4.88 to –.84]; P = .006). Mortality was similar in both arms (16.6% vs 20.0%; P = .263). In subgroup analyses by type of pathogen, we noted a trend of shorter mean antibiotic durations in the PCT arm for patients infected with gram-positive organisms or Escherichia coli and significantly shorter treatment for subjects with pneumococcal bacteremia. In analysis by site of infection, antibiotic exposure was shortened in PCT subjects with Streptococcus pneumoniae respiratory infection and those with E. coli urogenital infections. Conclusions This meta-analysis of patients with bacteremia receiving PCT-guided antibiotic management demonstrates lower antibiotic exposure without an apparent increase in mortality. Few differences were demonstrated in subgroup analysis stratified by type or site of infection but notable for decreased exposure in patients with pneumococcal pneumonia and E. coli urogenital infections.Fundo Se o manejo antibiótico guiado por procalcitonina (PCT) em pacientes com hemoculturas positivas é seguro permanece pouco estudado. Realizamos uma meta-análise em nível de paciente para investigar os efeitos do manejo antibiótico guiado por PCT em pacientes com bacteremia. Métodos Extraímos e analisamos dados individuais de 523 pacientes com hemoculturas positivas incluídos em 13 ensaios, nos quais os pacientes foram aleatoriamente designados para receber antibióticos com base nos níveis de PCT (grupo PCT) ou um grupo controle. O principal parâmetro de eficácia foi a duração do tratamento com antibióticos. O principal parâmetro de segurança foi a mortalidade em 30 dias. Resultados A duração média da antibioticoterapia foi significativamente menor para 253 pacientes que receberam tratamento guiado por PCT do que para 270 pacientes controle (–2,86 dias [intervalo de confiança de 95% [IC], –4,88 a –,84]; P = 0,006). A mortalidade foi semelhante em ambos os braços (16,6% vs 20,0%; P = 0,263). Em análises de subgrupo por tipo de patógeno, observamos uma tendência de duração média de antibióticos mais curta no braço de PCT para pacientes infectados com organismos gram-positivos ou Escherichia coli e tratamento significativamente mais curto para indivíduos com bacteremia pneumocócica. Na análise por local de infecção, a exposição a antibióticos foi reduzida em indivíduos PCT com infecção respiratória por Streptococcus pneumoniae e naqueles com infecções urogenitais por E. coli. Conclusões Esta meta-análise de pacientes com bacteremia recebendo tratamento antibiótico guiado por PCT demonstra menor exposição a antibióticos sem um aumento aparente na mortalidade. Poucas diferenças foram demonstradas na análise de subgrupos estratificados por tipo ou local de infecção, mas notáveis pela diminuição da exposição em pacientes com pneumonia pneumocócica e infecções urogenitais por E. coli.engUniversidade Federal de Minas GeraisUFMGBrasilMED - DEPARTAMENTO DE CLÍNICA MÉDICAClinical infectious diseasesHemoculturas positivasBacteremiaAdministração de antibióticosProcalcitoninaProcalcitonin-guided antibiotic treatment in patients with positive blood cultures: a patient-level meta-analysis of randomized trialsTratamento antibiótico guiado por procalcitonina em pacientes com hemoculturas positivas: uma meta-análise em nível de paciente de estudos randomizadosinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://academic.oup.com/cid/article/69/3/388/5144566?login=falseMarc AmeierFlorence TubachMirjam Christ-CrainCaspar CortiJens-Ulrik JensenRodrigo DeliberatoKristina KristoffersenPierre DamasVandack NobreCarolina Ferreira de OliveiraYahya ShehabiAngela BrancheDaiana StolzMichael TammBeat MuellerPhilipp SchuetzOlivia I. NeeserYannick WirzSebastian HaubitzLila BouadmaMichel WolffCharles E. LuytJean Chastreapplication/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/1843/42635/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINAL2019_Procalcitonin-guided antibiotic treatment in patients with positive blood cultures- a patient-level meta-analysis of randomized trials.pdf2019_Procalcitonin-guided antibiotic treatment in patients with positive blood cultures- a patient-level meta-analysis of randomized trials.pdfapplication/pdf278852https://repositorio.ufmg.br/bitstream/1843/42635/2/2019_Procalcitonin-guided%20antibiotic%20treatment%20in%20patients%20with%20positive%20blood%20cultures-%20a%20patient-level%20meta-analysis%20of%20randomized%20trials.pdf02b25632cb27876be352aa328949918cMD521843/426352022-06-23 18:53:56.653oai:repositorio.ufmg.br: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Repositório de PublicaçõesPUBhttps://repositorio.ufmg.br/oaiopendoar:2022-06-23T21:53:56Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false |
dc.title.pt_BR.fl_str_mv |
Procalcitonin-guided antibiotic treatment in patients with positive blood cultures: a patient-level meta-analysis of randomized trials |
dc.title.alternative.pt_BR.fl_str_mv |
Tratamento antibiótico guiado por procalcitonina em pacientes com hemoculturas positivas: uma meta-análise em nível de paciente de estudos randomizados |
title |
Procalcitonin-guided antibiotic treatment in patients with positive blood cultures: a patient-level meta-analysis of randomized trials |
spellingShingle |
Procalcitonin-guided antibiotic treatment in patients with positive blood cultures: a patient-level meta-analysis of randomized trials Marc Ameier Hemoculturas positivas Bacteremia Administração de antibióticos Procalcitonina |
title_short |
Procalcitonin-guided antibiotic treatment in patients with positive blood cultures: a patient-level meta-analysis of randomized trials |
title_full |
Procalcitonin-guided antibiotic treatment in patients with positive blood cultures: a patient-level meta-analysis of randomized trials |
title_fullStr |
Procalcitonin-guided antibiotic treatment in patients with positive blood cultures: a patient-level meta-analysis of randomized trials |
title_full_unstemmed |
Procalcitonin-guided antibiotic treatment in patients with positive blood cultures: a patient-level meta-analysis of randomized trials |
title_sort |
Procalcitonin-guided antibiotic treatment in patients with positive blood cultures: a patient-level meta-analysis of randomized trials |
author |
Marc Ameier |
author_facet |
Marc Ameier Florence Tubach Mirjam Christ-Crain Caspar Corti Jens-Ulrik Jensen Rodrigo Deliberato Kristina Kristoffersen Pierre Damas Vandack Nobre Carolina Ferreira de Oliveira Yahya Shehabi Angela Branche Daiana Stolz Michael Tamm Beat Mueller Philipp Schuetz Olivia I. Neeser Yannick Wirz Sebastian Haubitz Lila Bouadma Michel Wolff Charles E. Luyt Jean Chastre |
author_role |
author |
author2 |
Florence Tubach Mirjam Christ-Crain Caspar Corti Jens-Ulrik Jensen Rodrigo Deliberato Kristina Kristoffersen Pierre Damas Vandack Nobre Carolina Ferreira de Oliveira Yahya Shehabi Angela Branche Daiana Stolz Michael Tamm Beat Mueller Philipp Schuetz Olivia I. Neeser Yannick Wirz Sebastian Haubitz Lila Bouadma Michel Wolff Charles E. Luyt Jean Chastre |
author2_role |
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 |
Marc Ameier Florence Tubach Mirjam Christ-Crain Caspar Corti Jens-Ulrik Jensen Rodrigo Deliberato Kristina Kristoffersen Pierre Damas Vandack Nobre Carolina Ferreira de Oliveira Yahya Shehabi Angela Branche Daiana Stolz Michael Tamm Beat Mueller Philipp Schuetz Olivia I. Neeser Yannick Wirz Sebastian Haubitz Lila Bouadma Michel Wolff Charles E. Luyt Jean Chastre |
dc.subject.other.pt_BR.fl_str_mv |
Hemoculturas positivas Bacteremia Administração de antibióticos Procalcitonina |
topic |
Hemoculturas positivas Bacteremia Administração de antibióticos Procalcitonina |
description |
Background Whether procalcitonin (PCT)–guided antibiotic management in patients with positive blood cultures is safe remains understudied. We performed a patient-level meta-analysis to investigate effects of PCT-guided antibiotic management in patients with bacteremia. Methods We extracted and analyzed individual data of 523 patients with positive blood cultures included in 13 trials, in which patients were randomly assigned to receive antibiotics based on PCT levels (PCT group) or a control group. The main efficacy endpoint was duration of antibiotic treatment. The main safety endpoint was mortality within 30 days. Results Mean duration of antibiotic therapy was significantly shorter for 253 patients who received PCT-guided treatment than for 270 control patients (–2.86 days [95% confidence interval [CI], –4.88 to –.84]; P = .006). Mortality was similar in both arms (16.6% vs 20.0%; P = .263). In subgroup analyses by type of pathogen, we noted a trend of shorter mean antibiotic durations in the PCT arm for patients infected with gram-positive organisms or Escherichia coli and significantly shorter treatment for subjects with pneumococcal bacteremia. In analysis by site of infection, antibiotic exposure was shortened in PCT subjects with Streptococcus pneumoniae respiratory infection and those with E. coli urogenital infections. Conclusions This meta-analysis of patients with bacteremia receiving PCT-guided antibiotic management demonstrates lower antibiotic exposure without an apparent increase in mortality. Few differences were demonstrated in subgroup analysis stratified by type or site of infection but notable for decreased exposure in patients with pneumococcal pneumonia and E. coli urogenital infections. |
publishDate |
2019 |
dc.date.issued.fl_str_mv |
2019 |
dc.date.accessioned.fl_str_mv |
2022-06-23T21:53:56Z |
dc.date.available.fl_str_mv |
2022-06-23T21:53:56Z |
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/1843/42635 |
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10.1093/cid/ciy917 |
dc.identifier.issn.pt_BR.fl_str_mv |
1058-4838 |
identifier_str_mv |
10.1093/cid/ciy917 1058-4838 |
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http://hdl.handle.net/1843/42635 |
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eng |
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eng |
dc.relation.ispartof.pt_BR.fl_str_mv |
Clinical infectious diseases |
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openAccess |
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Universidade Federal de Minas Gerais |
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UFMG |
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Brasil |
dc.publisher.department.fl_str_mv |
MED - DEPARTAMENTO DE CLÍNICA MÉDICA |
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Universidade Federal de Minas Gerais |
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