title: An ESICM systematic review and meta-analysis of procalcitonin-guided antibiotic therapy algorithms in adult critically ill patients.
abstract: OBJECTIVE
  We sought to perform a systematic review and meta-analysis of procalcitonin(PCT)-guided antibiotic therapy algorithms for critically ill adult patients.
  
  
  METHODS
  We performed a search in PubMed and in the Cochrane Central Register of Controlled Trials. Seven evaluable randomised clinical trials (RCTs) were identified and analysed. Primary outcomes included the duration of antibiotic therapy for the first episode of infection and 28-day mortality. Secondary outcomes included length of ICU stay, length of hospitalisation, antibiotic-free days within the first 28 days of hospitalisation, recurrences, and superinfections.
  
  
  RESULTS
  Data on the duration of antibiotic therapy for the first episode of infection were provided in five out of seven included RCTs, while data on 28-day mortality were provided in all of the included RCTs. Duration of antibiotic therapy for the first episode of infection was reduced in favour of PCT-guided treatment [pooled weighted mean difference (WMD) = -3.15 days, random effects model, 95 % confidence interval (CI) -4.36 to -1.95, P < 0.001]. There was no difference in 28-day mortality between the compared arms [fixed effect model (FEM), odds ratio = 0.96, 95 % CI 0.79-1.15, P = 0.63). Antibiotic-free days were increased within the first 28 days of hospitalisation in favour of the PCT-guided treatment arm (pooled WMD = 3.08 days, FEM, 95 % CI 2.06-4.10, P < 0.001). No difference was found regarding the remaining outcomes. Sensitivity analyses including studies of higher quality and studies using the TRACE method to measure PCT yielded similar results.
  
  
  CONCLUSIONS
  Procalcitonin-guided antibiotic therapy algorithms could help in reducing the duration of antimicrobial administration without having a negative impact on survival.
authors.affiliation: Department of Internal Medicine, G. Gennimatas General Hospital, 41 Ethnikis Amynis Str., 546 35 Thessaloniki, Greece. d.matthaiou@gmail.com
authors.forename: Dimitrios K
authors.initials: DK
authors.lastname: Matthaiou
authors.forename: Georgia
authors.initials: G
authors.lastname: Ntani
authors.forename: Marina
authors.initials: M
authors.lastname: Kontogiorgi
authors.forename: Garyfallia
authors.initials: G
authors.lastname: Poulakou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganidis
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
mesh_terms: D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002116:Calcitonin / Q000627:therapeutic use*; D015740:Calcitonin Gene-Related Peptide; D016638:Critical Illness; D006801:Humans; D011498:Protein Precursors / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide