Clinical question: Can procalcitonin testing be used to determine whether antibiotics should be started and stopped?
Background: Procalcitonin naturally occurs in the body but increases with bacterial infection, with normal levels
Study design: Systematic review.
Setting: ICUs and EDs in Europe, China, and Brazil.
Synopsis: A systematic review of eight RCTs in the ICU showed that, in adults, procalcitonin testing decreased antibiotic duration (weighted mean difference [WMD] -3.2 days; 95% CI, -5.44 to -0.95), decreased hospital length of stay (WMD -3.85 days; 95% CI, -6.78 to -0.92), and trended toward decreased ICU length of stay (WMD -2.03 days; 95% CI, -4.19 to 0.13).
Further review of eight different trials looking at procalcitonin testing in the ED showed that, in adults with suspected bacterial infection, procalcitonin testing reduced proportion of adults receiving antibiotics (relative risk 0.77; 95% CI, 0.68–0.87) and a trend toward reduction in hospital stays. No strong conclusions could be made about the effect on duration of antibiotic therapy. Procalcitonin testing was demonstrated to be cost-effective in the study population, saving £3,268 in adults with sepsis in the ICU.
Most studies were of unclear quality and unclear risk of bias secondary to insufficient reporting; therefore, results must be interpreted with caution.
Bottom line: Procalcitonin testing may be a cost-saving measure for adults with sepsis in the ICU and adults with possible bacterial infections in the ED.
Citation: Westwood M, Raemaekers B, Whiting P, et al. Procalcitonin testing to guide antibiotic therapy for the treatment of sepsis in intensive care settings and for suspected bacterial infection in emergency department settings: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2015;19(96):1-236.
Adjuvant Flu Vaccine Approved for Prevention of Seasonal Influenza
The FDA approved Fluad, an adjuvanted trivalent vaccine, for the prevention of seasonal influenza in patients >65 years of age based on studies showing comparable safety and immunogenicity to Agriflu, a FDA-approved unadjuvanted trivalent vaccine.
Citation: FDA approves first seasonal influenza vaccine containing an adjuvant [news release]. Washington, DC: FDA; November 24, 2015