Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials.
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Heilmann Eva, Gregoriano Claudia, Annane Djillali, Reinhart Konrad, Bouadma Lila, Wolff Michel, Chastre Jean, Luyt Charles-Edouard, Tubach Florence, Branche Angela R, Briel Matthias, Christ-Crain Mirjam, Welte Tobias, Corti Caspar, de Jong Evelien, Nijsten Maarten, de Lange Dylan W, van Oers Jos A H, Beishuizen Albertus, Girbes Armand R J, Deliberato Rodrigo O, Schroeder Stefan, Kristoffersen Kristina B, Layios Nathalie, Damas Pierre, Lima Stella S S, Nobre Vandack, Wei Long, Oliveira Carolina F, Shehabi Yahya, Stolz Daiana, Tamm Michael, Verduri Alessia, Wang Jin-Xiang, Drevet Sabine, Gavazzi Gaetan, Mueller Beat, Schuetz Philipp
Аннотация
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.