title: Procalcitonin to guide duration of antimicrobial therapy in intensive care units: a systematic review.
abstract: Can the use of serum procalcitonin levels safely reduce antimicrobial use in intensive care unit (ICU) patients? We performed a systematic literature review that identified 6 published randomized controlled trials comparing PCT-guided antimicrobial therapy to usual care in ICU patients, extracting data on ICU and patient characteristics, PCT guideline content, intensity of antimicrobial exposure, ICU length of stay, infection relapse, and mortality. Procalcitonin guidance was associated with significantly reduced antimicrobial exposure (effect sizes, 19.5%-38%) in all 5 studies assessing its impact on treatment duration but did not significantly impact antimicrobial exposure in the study assessing treatment initiation only. Length of ICU stay was significantly decreased in 2 studies but was unchanged in the others. Neither infection relapse nor mortality varied significantly in any of the studies. Procalcitonin guidance of antimicrobial duration appears to decrease antimicrobial use in the ICU safely and significantly and may also decrease the length of stay in the ICU.
authors.affiliation: Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois 60612, USA. rajender.agarwal@gmail.com
authors.forename: Rajender
authors.initials: R
authors.lastname: Agarwal
authors.forename: David N
authors.initials: DN
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000097:blood*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D006801:Humans; D057970:Inappropriate Prescribing; D007362:Intensive Care Units; D011498:Protein Precursors / Q000097:blood*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide