Procalcitonin to Guide Initiation and Duration of Antibiotic Treatment in Acute Respiratory Infections: An Individual Patient Data Meta-Analysis
Procalcitonin to Guide Initiation and Duration of Antibiotic Treatment in Acute Respiratory Infections: An Individual Patient Data Meta-Analysis
复制标题
DOI：
10.1093/cid/cis464
复制
发表时间：
2012-09-01
影响因子：
11.8
通讯作者：
Mueller, Beat
中科院分区：
文献类型：
--
作者：
Schuetz, Philipp;Briel, Matthias;Mueller, Beat
背景降钙素原算法可减少急性呼吸道感染（阿里斯）的抗生素使用。我们进行了一项个体患者数据荟萃分析，以评估这种方法在不同ARI诊断和不同临床环境中的安全性。通过检索科克伦注册中心、MEDLINE和EMBASE，我们确定了ARI患者根据降钙素原算法或常规护理接受抗生素治疗的临床试验。对14项试验中4221例阿里斯成人患者的个体数据进行了验证和再分析，以评估死亡率和治疗失败的风险-总体和不同临床环境和类型的ARIS.Results.总体而言，2085例患者（5.7%）分配到降钙素原组，118例死亡，而2126例对照组患者中有134例死亡（6.3%;校正比值比，0.94; 95%置信区间CI，0.71 -1.23）。降钙素原组398例患者（19.1%）和对照组466例患者（21.9%;校正比值比，0.82; 95%CI，0.71 - 0.97）发生治疗失败。在任何临床环境或ARI诊断中，降钙素原指导与死亡率增加或治疗失败无关。每例患者的抗生素总暴露量总体上显著降低（中位数[四分位距]，从8 [5-12]天降至4 [0-8]天;校正后的天数差异，-3.47 [95%CI，-3.78至-3.17]），并且在所有临床环境和ARI诊断中均显著降低。使用降钙素原指导阿里斯患者抗生素治疗的开始和持续时间，可有效降低各种环境下的抗生素暴露，而不会增加死亡或治疗失败的风险。需要在重症患者中进行进一步的高质量试验。
Background. Procalcitonin algorithms may reduce antibiotic use for acute respiratory tract infections (ARIs). We undertook an individual patient data meta-analysis to assess safety of this approach in different ARI diagnoses and different clinical settings.Methods. We identified clinical trials in which patients with ARI were assigned to receive antibiotics based on a procalcitonin algorithm or usual care by searching the Cochrane Register, MEDLINE, and EMBASE. Individual patient data from 4221 adults with ARIs in 14 trials were verified and reanalyzed to assess risk of mortality and treatment failure-overall and within different clinical settings and types of ARIs.Results. Overall, there were 118 deaths in 2085 patients (5.7%) assigned to procalcitonin groups compared with 134 deaths in 2126 control patients (6.3%; adjusted odds ratio, 0.94; 95% confidence interval CI, .71-1.23)]. Treatment failure occurred in 398 procalcitonin group patients (19.1%) and in 466 control patients (21.9%; adjusted odds ratio, 0.82; 95% CI,.71-.97). Procalcitonin guidance was not associated with increased mortality or treatment failure in any clinical setting or ARI diagnosis. Total antibiotic exposure per patient was significantly reduced overall (median [interquartile range], from 8 [5-12] to 4 [0-8] days; adjusted difference in days, -3.47 [95% CI, -3.78 to -3.17]) and across all clinical settings and ARI diagnoses.Conclusions. Use of procalcitonin to guide initiation and duration of antibiotic treatment in patients with ARIs was effective in reducing antibiotic exposure across settings without an increase in the risk of mortality or treatment failure. Further high-quality trials are needed in critical-care patients.