Trial reportJAMA2025
Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial.
Trial report in JAMA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 60 papers, 2 of them syntheses that pooled 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.
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.
Who cites it
60 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Pooled it
- Efficacy and Safety of Procalcitonin-Guided Antibiotic Therapy versus Standard of Care for Sepsis: A Systematic Review and Meta-Analysis.Medical principles and practice : international journal of the Kuwait University, Health Science Centre · 2026Pooled it
- Empirical Meropenem Versus Piperacillin/Tazobactam for Critically Ill Adults With Sepsis: Feasibility of a Randomised Trial.Acta anaesthesiologica Scandinavica · 2026Trial
- Procalcitonin to Guide 7 vs 14 Days of Antibiotics in Bloodstream Infections: A Secondary Analysis of the BALANCE Trial.JAMA network open · 2026Trial
- Machine says go, doctor says no: an ecological momentary assessment analysis examining clinicians' perceptions of, and their antibiotic prescribing behaviour when using rapid molecular diagnostic tests in intensive care.Antimicrobial resistance and infection control · 2026Trial
- Effect of preoperative oral carbohydrate combined with postoperative early enteral nutrition on the perioperative rehabilitation of patients with colorectal cancer: a multicenter randomized controlled trial.Frontiers in nutrition · 2025Trial
- METTL7B Expression in Sepsis: Association With Disease Severity and 28-Day Mortality.Journal of clinical laboratory analysis · 2026Article
- Recent advances in screening, diagnosis, prognosis and personalized treatment of sepsis.European journal of microbiology & immunology · 2026Review
- Use of procalcitonin point-of-care testing to guide de-escalation of antibiotic therapy in adults with suspected bacterial sepsis in a tertiary hospital in Bangladesh: a randomised controlled open-label trial.EClinicalMedicine · 2026Article
- Day-7 lactate-to-albumin ratio as a prognostic marker in sepsis patients requiring prolonged mechanical ventilation: a multicenter retrospective landmark analysis of the Korean Sepsis Alliance registry.Journal of thoracic disease · 2026Article
- Significant Publications on Infectious Diseases Pharmacotherapy in 2024.Journal of pharmacy practice · 2026Review
- Application of a machine learning model integrating T cell subsets and clinical markers in 28-Day mortality prediction of sepsis patients.Clinical and experimental medicine · 2026Article
- Clinical evaluation of the SeptiScore biomarker for the diagnosis of healthcare-associated infections in critically ill trauma patients: a multicenter derivation and validation cohort study.BMC anesthesiology · 2026Observational
- Review
- Implementation of procalcitonin-guided antibiotic stopping advice in sepsis: A mixed-methods process evaluation in a clinical trial context.Journal of the Intensive Care Society · 2026Article
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- What's Hot This Year in ID Clinical Science 2025.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Review
- Comparison of NLR and CRP in Identifying Organ Dysfunction-Based Severe Presentation of Acute Cholangitis in Patients with Choledocholithiasis: A Single-Center Retrospective Study.Medicina (Kaunas, Lithuania) · 2026Article
- The Role and Importance of Procalcitonin (PCT) Testing in Rational Antibiotic Prescribing and Antibiotic Stewardship Programs.Immunity, inflammation and disease · 2026Review
- Article
Corrections and comments
- Erratum issued
Authors and funding
33 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: For hospitalized critically ill adults with suspected sepsis, procalcitonin (PCT) and C-reactive protein (CRP) monitoring protocols can guide the duration of antibiotic therapy, but the evidence of the effect and safety of these protocols remains uncertain. Objective: To determine whether decisions based on assessment of CRP or PCT safely results in a reduction in the duration of antibiotic therapy. Design, Setting, and Participants: A multicenter, intervention-concealed randomized clinical trial, involving 2760 adults (≥18 years), in 41 UK National Health Service (NHS) intensive care units, requiring critical care within 24 hours of initiating intravenous antibiotics for suspected sepsis and likely to continue antibiotics for at least 72 hours. Intervention: From January 1, 2018, to June 5, 2024, 918 patients were assigned to the daily PCT-guided protocol, 924 to the daily CRP-guided protocol, and 918 assigned to standard care. Main Outcomes and Measures: The primary outcomes were total duration of antibiotics (effectiveness) and all-cause mortality (safety) to 28 days. Secondary outcomes included critical care unit data and hospital stay data. Ninety-day all-cause mortality was also collected. Results: Among the randomized patients (mean age 60.2 [SD, 15.4] years; 60.3% males), there was a significant reduction in antibiotic duration from randomization to 28 days for those in the daily PCT-guided protocol compared with standard care (mean duration, 10.7 [SD, 7.6] days for standard care and 9.8 [SD, 7.2] days for PCT; mean difference, 0.88 days; 95% CI, 0.19 to 1.58, P = .01). For all-cause mortality up to 28 days, the daily PCT-guided protocol was noninferior to standard care, where the noninferiority margin was set at 5.4% (19.4% [170 of 878] of patients receiving standard care; 20.9% [184 of 879], PCT; absolute difference, 1.57; 95% CI, -2.18 to 5.32; P = .02). No difference was found in antibiotic duration for standard care vs daily CRP-guided protocol (mean duration, 10.6 [7.7] days for CRP; mean difference, 0.09; 95% CI, -0.60 to 0.79; P = .79). For all-cause mortality, the daily CRP-guided protocol was inconclusive compared with standard care (21.1% [184 of 874] for CRP; absolute difference, 1.69; 95% CI, -2.07 to 5.45; P = .03). Conclusions and Relevance: Care guided by measurement of PCT reduces antibiotic duration safely compared with standard care, but CRP does not. All-cause mortality for CRP was inconclusive. Trial Registration: isrctn.org Identifier: ISRCTN47473244.
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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.