Effect of Procalcitonin-Guided Treatment in Patients with Infections: a Systematic Review and Meta-Analysis

Objective: The aim of this study was to review the effectiveness of procalcitonin (PCT)-guided therapy in companson to standard therapy in patients with suspected or confirmed bacterial infections in terms of antibiotic prescription at inclusion, duration of antibiotic therapy, total antibiotic exposure days/1,000 days, length of stay in the intensive care unit (ICU), Length of stay in the hospital, and mortality. Methods: MEDLINE, EMBASE, Web of Science, and the Cochrane central register of controlled trials were searched up to November 2008. Studies considered to be eligible were randomized controlled trials comparing PCT-guided therapy with standard therapy in adult patients with bacterial infections. No language restriction was applied. Data were combined in a meta-analysis using random-effect models. Results: Seven studies with 1,458 patients were included. PCT-guided therapy was associated with a significant reduction in antibiotic prescription at inclusion (four studies; pooled odds ratio [OR] 0.506, 95% confidence interval [CI] 0.290-0.882, p = 0.016), duration of antibiotic therapy (six studies; weighted mean difference [WMD] 2.785, 95% CI 1.225-4.345, p = 0.000), total antibiotic exposure days/1,000 days (four studies; pooled relative risk [RR] 1.664, 95% CI 1.155-2.172, p = 0.000), and length of stay in the ICU (three studies; 292 patients; pooled WMD 3.49 days, 95% CI 1.28-5.70, p = 0.002). There were no significant differences in length of stay in the hospital (three studies; pooled WMD 1.003, 95% CI -0.430 to 2.437, p = 0.17) and mortality (seven studies; pooled OR 0.838, 95% CI 0.571-1.229, p = 0.365). Conclusions: Based on the results of this meta-analysis, it would appear that an algorithm based on serial PCT measurements would allow a more judicious use of antibiotics than currently occurs during the traditional treatment of patients with infections. PCT-guided antibiotic treatment appears to be safe and may also improve clinical outcome.