Data show no effect on mortality from procalcitonin-based guidance
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Implementation of a procalcitonin-guided antibiotic prescription guideline did not affect 90-day or 12-month mortality compared with standard care among patients who presented to an ED for suspected lower respiratory tract infections, according to study results.
“We recently reported the primary results of the Procalcitonin Antibiotic Consensus Trial (ProACT), which showed that implementation of a guideline for procalcitonin-guided prescription of antibiotic agents for patients with suspected lower respiratory tract infection did not result in less exposure to antibiotics or more frequent adverse outcomes by 30 days,” David T. Huang, MD, MPH, associate professor of critical care medicine and emergency medicine at the University of Pittsburgh, and colleagues wrote.
According to the initial 30-day study, exposure was 4.2 antibiotic days in the procalcitonin group and 4.3 antibiotic days in the usual-care group, for a difference of –0.05 (95% CI, –0.6 to 0.5).
Following those results, Huang and colleagues evaluated the 90-day and 1-year mortality from ProACT participants by calculating mortality using Kaplan-Meier curves with censoring at days 90 and 365, according to the study.
Results showed that at 90 days, the Kaplan-Meier estimate of mortality was 2.8% (23 of 826 patients) in the procalcitonin group and 1.4% (12 of 830 patients) in the usual-care group (between-group difference, 1.3 percentage points; 95%, CI, –26.2 to 28.9). According to the study, at 1 year, the Kaplan–Meier estimate of mortality was 5.0% (41 of 826 patients) in the procalcitonin group and 5.3% (44 of 830 patients) in the usual-care group (between-group difference, –0.3 percentage points; 95%, CI, –34.7 to 34.0).
“We conclude that implementation of a procalcitonin-guided antibiotic prescription guideline did not affect longer-term mortality,” the authors concluded. “These results are consistent with the 30-day results we published previously.” – by Caitlyn Stulpin
Disclosures: Huang reports receiving nonfinancial support from bioMérieux during the study. Please see the study for all other authors’ relevant financial disclosures.
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