Procalcitonin Monitoring May Decrease Antibiotic Use in the Intensive Care Unit
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Purpose
Sepsis is common and is associated with significant mortality, morbidity and health-care costs. Unfortunately, its diagnosis is not straightforward because its signs and symptoms are neither specific nor sensitive; in addition, microbiological cultures lack specificity, sensitivity and are plagued by high turn-around times. Because the delay in the institution of antimicrobial therapy may be deleterious, broad-spectrum antibiotics are widely used in ICU-patients, even when they are not needed. Procalcitonin may not be the long sought for bio-marker to establish the diagnosis of sepsis but may help decrease the duration of the administered antibiotic courses once they are started.
| Condition | Intervention |
|---|---|
|
Sepsis |
Other: Literature search |
| Study Type: | Observational |
| Official Title: | Procalcitonin-guided Algorithms of Antibiotic Stewardship in the Intensive Care Unit: Systematic Review and Meta-analysis |
- Duration of antibiotic treatment for the first episode of infection [ Designated as safety issue: No ]
- Total duration of antibiotic therapy [ Designated as safety issue: No ]
- Antibiotic-free days at 28 days after study enrollment [ Designated as safety issue: No ]
- 28-day mortality [ Designated as safety issue: No ]
- In-hospital mortality [ Designated as safety issue: Yes ]
- Length of ICU stay [ Designated as safety issue: Yes ]
- Length of hospital stay [ Designated as safety issue: Yes ]
- Days free of mechanical ventilation at 28 days after study enrollment [ Designated as safety issue: Yes ]
- Rates of relapsed/persistent infection [ Designated as safety issue: Yes ]
- Rate of superinfection [ Designated as safety issue: Yes ]
- Financial cost of implementing a procalcitonin-based algorithm: purchase of the laboratory equipment/reagents, cost of the administered antibiotics, charges for hospital stay etc [ Designated as safety issue: No ]
| Study Start Date: | January 2010 |
| Estimated Study Completion Date: | March 2010 |
| Estimated Primary Completion Date: | February 2010 (Final data collection date for primary outcome measure) |
| Groups/Cohorts | Assigned Interventions |
|---|---|
| Procalcitonin-guided group |
Other: Literature search
Literature search followed by systematic review and meta-analysis
|
| Routine practice group |
Other: Literature search
Literature search followed by systematic review and meta-analysis
|
Detailed Description:
Recently, a number of studies have shown the utility of procalcitonin (PCT) measurements in reducing the duration of antibiotic treatment in patients with respiratory tract infections presenting to the primary care setting or the emergency department. However, it remains unclear if a similar strategy can be effectively and safely implemented in the critical care setting. We attempt to address the controversy on this issue, by collecting, analyzing and interpreting the currently available relevant evidence. To this end, a systematic review and meta-analysis of the randomized controlled trials reporting on the outcomes of critically ill septic patients managed with or without a procalcitonin-based algorithm will be performed.
Eligibility| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
| Sampling Method: | Probability Sample |
We will systematically search PubMed, Scopus and the Cochrane Central Register of Controlled Trials to identify relevant randomized controlled trials by using the following search terms: procalcitonin AND ("critically ill" OR "intensive care" OR "critical care"). The reference lists of the initially retrieved articles will also be reviewed. Abstracts of conference proceedings will not be sought because they commonly present data that differ from the full publications. Finally, the corresponding authors of each one of the included studies will be contacted by e-mail for additional information and clarifications if needed.
Inclusion Criteria:
- Randomized controlled trials (RCTs) that report on the outcomes of critically ill patients managed with a procalcitonin-guided algorithm versus routine practice.
- Participants of any age with proven or suspected sepsis will be considered. - As routine practice, the investigators will consider the institution and discontinuation of antibiotics by the attending physicians with the aid of clinical signs, symptoms, microbiological data, well established laboratory parameters (i.e., white blood cell count) and widely accepted guidelines but without the knowledge of PCT values. The investigators will set no limitations regarding the time, country or language of publications. The investigators will search for trials conducted in critically ill neonates and children.
Exclusion Criteria:
- The investigators will exclude studies that are not RCTs and studies performed outside the ICU, namely in the primary care setting, the emergency department or the clinic.
Contacts and Locations More Information
Publications:
| Responsible Party: | Petros Kopterides, MD, University of Athens Medical School, 2nd Critical Care Department, "Attiko" University Hospital |
| ClinicalTrials.gov Identifier: | NCT01085994 History of Changes |
| Other Study ID Numbers: | PCT-2010 |
| Study First Received: | March 11, 2010 |
| Last Updated: | October 6, 2010 |
| Health Authority: | Greece: Ministry of Health |
Keywords provided by University of Athens:
|
antibiotics resistance bio-marker |
procalcitonin algorithm critically ill |
Additional relevant MeSH terms:
|
Sepsis Infection Systemic Inflammatory Response Syndrome Inflammation Pathologic Processes |
Anti-Bacterial Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions |
ClinicalTrials.gov processed this record on June 18, 2013