[en] BACKGROUND: Use of serum procalcitonin (PCT), an inflammatory biomarker for bacterial infections, has shown promising results for early stopping antibiotic treatment among patients with respiratory infections and sepsis. There is need for additional data regarding effectiveness and safety of this concept among patients with cancer.
METHODS: Individual data of patients with a documented diagnosis of cancer and proven or suspected respiratory infection and/or sepsis were extracted from previous trials where adult patients were randomized to receive antibiotic treatment based on a PCT protocol or usual care (control group). The primary efficacy and safety endpoints were antibiotic exposure and 28-day all-cause mortality.
RESULTS: This individual-patient data meta-analysis included 777 patients with a diagnosis of cancer from 15 randomized-controlled trials. Regarding efficacy, there was a 18% reduction in antibiotic exposure in patients randomized to PCT-guided care compared to usual care ([days] 8.2 ± 6.6 vs. 9.8 ± 7.3; adjusted difference, - 1.77 [95% CI, - 2.74 to - 0.80]; p < 0.001). Regarding safety, there were 72 deaths in 379 patients in the PCT-guided group (19.0%) compared to 91 deaths in 398 participants in the usual care group (22.9%) resulting in an adjusted OR of 0.78 (95% CI, 0.60 to 1.02). A subgroup analysis showed a significant reduction in mortality in patients younger than 70 years (adjusted OR, 0.58 [95% CI, 0.40 to 0.86]).
CONCLUSION: Result of this individual patient meta-analysis from 15 previous trials suggests that among patients with cancer and suspected or proven respiratory infection or sepsis, use of PCT to guide antibiotic treatment decisions results in reduced antibiotic exposure with a possible reduction in mortality, particularly among younger patients.
Disciplines :
Oncology
Author, co-author :
Gregoriano, Claudia; Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
Wirz, Yannick; Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
Heinsalo, Ashley; Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
Annane, Djilali; IHU PROMETHEUS, Raymond Poincaré Hospital (APHP), INSERM, Université Paris Saclay Campus Versailles, Paris, France
Reinhart, Konrad; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
Bouadma, Lila; Médecine intensive-réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
Christ-Crain, Mirjam; Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
Kristoffersen, Kristina B; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
Damas, Pierre ; Université de Liège - ULiège > Département des sciences cliniques
Nobre, Vandack; Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Oliveira, Carolina F; Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Shehabi, Yahya; Department of Intensive Care, Monash Medical Centre, Melbourne, VIC, Australia
Stolz, Daiana; Clinic of Respiratory Medicine, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Verduri, Alessia; Respiratory Unit, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, Modena, Italy
Mueller, Beat; Medical University Department, Kantonsspital Aarau, Aarau, Switzerland ; Department of Clinical Research (DKF), Faculty of Medicine, University of Basel, Basel, Switzerland
Schuetz, Philipp; Medical University Department, Kantonsspital Aarau, Aarau, Switzerland. schuetzph@gmail.com ; Department of Clinical Research (DKF), Faculty of Medicine, University of Basel, Basel, Switzerland. schuetzph@gmail.com ; University Department of Medicine, Kantonsspital Aarau Tellstrasse, Aarau, CH-5001, Switzerland. schuetzph@gmail.com
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