Huang Hui-Bin, Peng Jin-Min, Weng Li, Wang Chun-Yao, Jiang Wei, Du Bin
Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Ann Intensive Care. 2017 Nov 22;7(1):114. doi: 10.1186/s13613-017-0338-6.
Serum procalcitonin (PCT) concentration is used to guide antibiotic decisions in choice, timing, and duration of anti-infection therapy to avoid antibiotic overuse. Thus, we performed a systematic review and meta-analysis to seek evidence of different PCT-guided antimicrobial strategies for critically ill patients in terms of predefined clinical outcomes.
We searched for relevant studies in PubMed, Embase, Web of Knowledge, and the Cochrane Library up to 25 February 2017. Randomized controlled trials (RCTs) were included if they reported data on any of the predefined outcomes in adult ICU patients managed with a PCT-guided algorithm or according to standard care. Results were expressed as risk ratio (RR) or mean difference (MD) with accompanying 95% confidence interval (CI).
We included 13 trials enrolling 5136 patients. These studies used PCT in three clinical strategies: initiation, discontinuation, or combination of antibiotic initiation and discontinuation strategies. Pooled analysis showed a PCT-guided antibiotic discontinuation strategy had fewer total days with antibiotics (MD - 1.66 days; 95% CI - 2.36 to - 0.96 days), longer antibiotic-free days (MD 2.26 days; 95% CI 1.40-3.12 days), and lower short-term mortality (RR 0.87; 95% CI 0.76-0.98), without adversely affecting other outcomes. Only few studies reported data on other PCT-guided strategies for antibiotic therapies, and the pooled results showed no benefit in the predefined outcomes.
Our meta-analysis produced evidence that among all the PCT-based strategies, only using PCT for antibiotic discontinuation can reduce both antibiotic exposure and short-term mortality in a critical care setting.
血清降钙素原（PCT）浓度用于指导抗感染治疗在选择、时机和疗程方面的抗生素决策，以避免抗生素过度使用。因此，我们进行了一项系统评价和荟萃分析，以寻找不同的PCT指导抗菌策略对危重症患者预定义临床结局影响的证据。
我们检索了截至2017年2月25日的PubMed、Embase、Web of Knowledge和Cochrane图书馆中的相关研究。纳入随机对照试验（RCT），如果这些试验报告了使用PCT指导算法或根据标准治疗管理的成年ICU患者任何预定义结局的数据。结果以风险比（RR）或平均差（MD）及伴随的95%置信区间（CI）表示。
我们纳入了13项试验，共5136例患者。这些研究在三种临床策略中使用了PCT：起始、停用或抗生素起始与停用策略的联合。汇总分析显示，PCT指导的抗生素停用策略使抗生素使用总天数减少（MD -1.66天；95%CI -2.36至-0.96天），无抗生素天数延长（MD 2.26天；95%CI 1.40 - 3.12天），短期死亡率降低（RR 0.87；95%CI 0.76 - 0.98），且未对其他结局产生不利影响。仅有少数研究报告了关于其他PCT指导的抗生素治疗策略的数据，汇总结果显示在预定义结局方面无益处。
我们的荟萃分析表明，在所有基于PCT的策略中，仅将PCT用于抗生素停用可在重症监护环境中减少抗生素暴露和短期死亡率。
