Procalcitonin-guided Antibiotic Use For Septic Patients-A Meta-analysis

Objective :This research is mainly to investigate the clinical effect of procalcitonin-guided therapy with antibiotics for the sepsis patients.Methods: we collected 875 related articles by retrieving the term “procalcitonin”,“sepsis”,“severe infection”,“antibiotics” and “anti-infective therapy”in Chinese at Wangfang Med Online,CNKI and Sino Med and in English at Pubmed,Web of science,ISI WOK.Then we make the strict inclusion criteria,The accepting criteria:(1)RCTs or cohort studies were selected,(2)In line with the international intensive medical association and the Chinese medical association of diagnostic criteria for severe infection or sepsis,(3)experimental group in the use of antibiotics must be conducted under the guidance of PCT,(4)The end point of observation including antibiotics application time,ICU admission time,total length of hospital stay,mortality of 28 days,at least three of the four,(5)Treatment must conform to the standard of clinical diagnosis and treatment principles,(6)Patients must be greater than 14 years old.The exclusion criteria:(1)Case reports and case series analysis,(2)Review and guide and other non-RCTs,(3)Articles that unable to get the full text,(4)Articles are not Chinese and not English,(5)Infection with mycobacterium tuberculosis or HIV virus or parasite.Finally meta analyzed eligible clinical trials by Stata Data Analysis System and Review Manager5.3.Continuous variables data were represented with mean difference(MD),95% CI;Eenumeration data were represented with odds ratio(OR),95% CI;Heterogeneity testing of the results: there were no significant heterogeneity,and the fixed effect model was used when I~2<50%,while there were marked heterogeneity and when I~2>50% we would use the random effects model.Results: Among the 875 articles we collected,7 articles,whose samples in total reaching 1520,were used in this research while the other 666 nonrandomized control and cohort study articles as well as 202 articles inconformity to this research were ruled out.By analyzing the time of antibiotics application,28 days mortality,ICU stay time and length of stay(LOS)with GRADE and Review Manager 5.3 software,we found that when antibiotic therapy was used to cure sepsis patients under PCT guidance,the time of antibiotics application [MD=-2.51,95%CI=(-3.45~-1.57),Z=5.23(P<0.00001)] and LOS [MD=-3.25,95%CI=(-6.23~-0.27),Z=2.14(P=0.03)] of PCT-guided group were statistically different compared with those of control group,but the 28 days mortality [OR=0.98(95%CI=0.81~ 1.19),Z=0.22(P=0.82)] and ICU stay time [MD=-1.32,95%CI=(-3.17~ 0.53),Z=1.39(P=0.16)]were statistically the same in both experimental group and control group.Conclusion: As for sepsis patients,compared with traditional anti-infection therapy,the application of antibiotics therapy under PCT guidance can shorten the time of using antibiotics without causing any negative effects.Consequently the length of stay for patients is also shorten,which will benefit the overall therapeutic effect.Therefore,Procalcitonin-guided therapy with antibiotics for the sepsis patients works well and safe.