Antibiotics duration guided by biomarkers in hospitalized adult patients; a systematic review and meta-analysis

Abstract

Background

The impact of using biomarkers to determine the duration of antibiotics therapy has been studied. However, the question remains in clinical practice whether these biomarkers are reliable to determine antibiotics duration.

Aim

This study is aimed to see if employing c-reactive protein (CRP) and Procalcitonin (PCT) to determine the duration of antibiotic use in hospitalized adult patients is both effective and safe.

Methods

Search databases that were used are Pubmed, Cochrane library, and Embase. Only randomized controlled trials conducted in adult (≥18 years) hospitalized patients were included. The primary outcome assessed is the duration of antibiotics used. Secondary outcomes assessed are the length of hospitalization, recurrence of infection/rehospitalization, in-hospital mortality, and 28-day mortality.

Results

For the primary outcome, which is the duration of antibiotics use, PCT guided therapy significantly decreased the duration of antibiotics used in both sepsis and respiratory tract infections. For the secondary outcomes, there was no statistically significant difference in the outcomes of length of hospitalization, recurrence of infection/rehospitalization, and 28-day mortality. However, in-hospital mortality was significantly reduced (p = .02). CRP guided reduced antibiotic use duration, but there was no statistically significant difference in other outcomes including length of hospital stay, 28-day mortality, and infection recurrence.

Conclusion

Procalcitonin-guided antibiotics therapy was shown to be effective and safe in the reduction of antibiotics duration in both sepsis and respiratory tract infections. More research is needed to prove that CRP-guided therapy is safe and effective to determine the antibiotic duration in adult hospitalized patients.

Review registration number

PROSPERO (CRD42021264167).

Keywords:

• Antibiotics
• procalcitonin
• C-reactive protein
• biomarkers
• antibiotics duration
• infection

Disclosure statement

None of the authors have any competing interests to report.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Table 5. Effect of procalcitonin guided therapy on 28-day mortality and in-hospital mortality.

Table 6. Effect of procalcitonin guided therapy on the recurrence of infection.

Table 7. Use of procalcitonin guided therapy in other indications.

Figure 1. Study selection process.

Figure 2. Effect of procalcitonin guided therapy on antibiotics duration.

Figure 3. Effect of procalcitonin guided therapy on 28-day mortality.

Figure 4. Effect of procalcitonin guided therapy on in-hospital mortality in sepsis.

Figure 5. Effect of procalcitonin guided therapy on the recurrence of infections.

Figure 6. Risk of bias presented as percentages across all included studies.

Figure 7. Risk of bias item for each included study.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.