Evidence map›Paper›PMID 33993243›Full record

SynthesisAge and ageing2021

Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients: a patient-level meta-analysis from randomized controlled trials.

Eva Heilmann, Claudia Gregoriano, Djillali Annane, Konrad Reinhart, Lila Bouadma, Michel Wolff, Jean Chastre, Charles-Edouard Luyt, Florence Tubach, Angela R Branche and 28 more

Open access · bronzeAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Age and ageing, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.1field-weighted citation impact, top 23% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Review
  4. Review
  5. Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

38 authors at 20 institutions in 11 countries.

Eva HeilmannMedical University Department, Kantonsspital Aarau, Aarau, Switzerland.
Claudia GregorianoMedical University Department, Kantonsspital Aarau, Aarau, Switzerland.
Djillali AnnaneDepartment of Critical Care, Hyperbaric Medicine and Home Respiratory Unit, Center for Neuromuscular Diseases, Raymond Poincaré Hospital (AP-HP), Garches, France.
Konrad ReinhartDepartment of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
Lila BouadmaService de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Univeersité Paris 7-Denis-Diderot, Paris, France.
Michel WolffService de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Univeersité Paris 7-Denis-Diderot, Paris, France.
Jean ChastreService de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Univeersité Paris 7-Denis-Diderot, Paris, France.
Charles-Edouard LuytService de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France.
Florence TubachDépartement d'Epidémiologie Biostatistique et Recherche Clinique, AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, Paris, France.
Angela R BrancheDepartment of Medicine, Rochester General Hospital, New York, NY, USA.
Matthias BrielInstitute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.
Mirjam Christ-CrainDivision of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Basel, Switzerland.
Tobias WelteDepartment of Pulmonary Medicine, Medizinische Hochschule Hannover, Hannover, Germany.
Caspar CortiDepartment of Respiratory Medicine, Hospital Bispebjerg, Copenhagen University, Copenhagen, Denmark.
Evelien de JongDepartment of Intensive Care, VU University Medical Center, Amsterdam, the Netherlands.
Maarten NijstenUniversity Medical Centre, University of Groningen, Groningen, the Netherlands.
Dylan W de LangeUniversity Medical Center Utrecht, Utrecht, the Netherlands.
Jos A H van OersDepartment of Intensive Care Medicine, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands.
Albertus BeishuizenMedisch Spectrum Twente, Enschede, the Netherlands.
Armand R J GirbesDepartment of Intensive Care, VU University Medical Center, Amsterdam, the Netherlands.
Rodrigo O DeliberatoCritical Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Stefan SchroederDepartment of Anesthesiology and Intensive Care Medicine, Krankenhaus Dueren, Dueren, Germany.
Kristina B KristoffersenDepartment of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.
Nathalie LayiosDepartment of General Intensive Care, University Hospital of Liege, Domaine Universitaire de Liège, Liege, Belgium.
Pierre DamasDepartment of General Intensive Care, University Hospital of Liege, Domaine Universitaire de Liège, Liege, Belgium.
Stella S S LimaDepartment of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Vandack NobreDepartment of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Long WeiDepartment of Medicine, Shanghai Fifth People's Hospital, Shanghai, China.
Carolina F OliveiraDepartment of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
Yahya ShehabiCritical Care and Peri-operative Medicine, Monash Health, Melbourne, Australia.
Daiana StolzClinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland.
Michael TammClinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland.
Alessia VerduriDepartment of Medical and Surgical Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
Jin-Xiang WangDepartment of Respiratory and Critical Care Medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China.
Sabine DrevetUniversity Clinics of Geriatrics, University Hospital of Grenoble-Alpes, GREPI TIMC-IMAG CNRS 5525 University of Grenoble Alpes, Grenoble, France.
Gaetan GavazziUniversity Clinics of Geriatrics, University Hospital of Grenoble-Alpes, GREPI TIMC-IMAG CNRS 5525 University of Grenoble Alpes, Grenoble, France.
Beat MuellerMedical University Department, Kantonsspital Aarau, Aarau, Switzerland.
Philipp SchuetzMedical University Department, Kantonsspital Aarau, Aarau, Switzerland.
Kantonsspital Aarau · CHUniversity Hospital of Basel · CHUniversidade Federal de Minas Gerais · BRAmsterdam UMC Location Vrije Universiteit Amsterdam · NLCentre Hospitalier Universitaire de Liège · BEDélégation Paris 7 · FRAarhus University Hospital · DKAssistance Publique – Hôpitaux de Paris · FRBeijing Luhe Hospital Affiliated to Capital Medical University · CNBispebjerg Hospital · DKCentre Hospitalier Universitaire de Grenoble · FRCentre National de la Recherche Scientifique · FRElisabeth-TweeSteden Ziekenhuis · NLHôpitaux Universitaires Paris-Ouest · FRHospital Israelita Albert Einstein · BRJena University Hospital · DEKrankenhaus Düren · DEMedisch Spectrum Twente · NLMedizinische Hochschule Hannover · DEMonash University · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOlder 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

designWe 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

methodsWe 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.

resultsCompared 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).

conclusionsThis 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.

Indexed as

Intensive Care UnitsProcalcitoninAgedAlgorithmsAnti-Bacterial AgentsHumansRandomized Controlled Trials as TopicAnti-Bacterial AgentsProcalcitoninageantibiotic stewardshipolder patientsprocalcitonin

Identifiers

PMID33993243
PMCPMC8437072
OpenAlexW3160307262

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.