TY - JOUR
T1 - Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients
T2 - A patient-level meta-analysis from randomized controlled trials
AU - Heilmann, Eva
AU - Gregoriano, Claudia
AU - Annane, Djillali
AU - Reinhart, Konrad
AU - Bouadma, Lila
AU - Wolff, Michel
AU - Chastre, Jean
AU - Luyt, Charles Edouard
AU - Tubach, Florence
AU - Branche, Angela R.
AU - Briel, Matthias
AU - Christ-Crain, Mirjam
AU - Welte, Tobias
AU - Corti, Caspar
AU - De Jong, Evelien
AU - Nijsten, Maarten
AU - De Lange, Dylan W.
AU - Van Oers, Jos A.H.
AU - Beishuizen, Albertus
AU - Girbes, Armand R.J.
AU - Deliberato, Rodrigo O.
AU - Schroeder, Stefan
AU - Kristoffersen, Kristina B.
AU - Layios, Nathalie
AU - Damas, Pierre
AU - Lima, Stella S.S.
AU - Nobre, Vandack
AU - Wei, Long
AU - Oliveira, Carolina F.
AU - Shehabi, Yahya
AU - Stolz, Daiana
AU - Tamm, Michael
AU - Verduri, Alessia
AU - Wang, Jin Xiang
AU - Drevet, Sabine
AU - Gavazzi, Gaetan
AU - Mueller, Beat
AU - Schuetz, Philipp
N1 - Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - 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.
AB - 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.
KW - age
KW - antibiotic stewardship
KW - older patients
KW - procalcitonin
UR - http://www.scopus.com/inward/record.url?scp=85116955794&partnerID=8YFLogxK
U2 - 10.1093/ageing/afab078
DO - 10.1093/ageing/afab078
M3 - Review
C2 - 33993243
AN - SCOPUS:85116955794
SN - 0002-0729
VL - 50
SP - 1546
EP - 1556
JO - Age and Ageing
JF - Age and Ageing
IS - 5
ER -