Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials.

Abstract

BACKGROUND:

Older patients have a less pronounced immune response to infection, which may also influence infection biomarkers. There is currently insufficient data regarding clinical effects of procalcitonin (PCT) to guide antibiotic treatment in older patients.

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.

• Authors: Eva Heilmann, Claudia Gregoriano, Djillali Annane, Konrad Reinhart, Lila Bouadma, Michel Wolff, Jean Chastre, Charles-Edouard Luyt, Florence Tubach, Angela R Branche, Matthias Briel, Mirjam Christ-Crain, Tobias Welte, Caspar Corti, Evelien de Jong, Maarten Nijsten, Dylan W de Lange, Jos A H van Oers, Albertus Beishuizen, Armand R J Girbes, Rodrigo O Deliberato, Stefan Schroeder, Kristina B Kristoffersen, Nathalie Layios, Pierre Damas, Stella S S Lima, Vandack Nobre, Long Wei, Carolina F Oliveira, Yahya Shehabi, Daiana Stolz, Michael Tamm, Alessia Verduri, Jin-Xiang Wang, Sabine Drevet, Gaetan Gavazzi, Beat Mueller, Philipp Schuetz
• Journal: Age and ageing (Age Ageing) Vol. 50 Issue 5 Pg. 1546-1556 (09 11 2021) ISSN: 1468-2834 [Electronic] England
• PMID: 33993243 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: [email protected].

Chemical References

• Anti-Bacterial Agents
• Procalcitonin

Topics

• Aged
• Algorithms
• Anti-Bacterial Agents (adverse effects)
• Humans
• Intensive Care Units
• Procalcitonin
• Randomized Controlled Trials as Topic